Department of Cardiosurgery, Fujian Provincial Hospital, 134 Dongjie Street, Fuzhou, Fujian, China.
Fujian Provincial Clinical College, Fujian Medical University, Fuzhou, Fujian, China.
Eur J Med Res. 2020 Mar 30;25(1):11. doi: 10.1186/s40001-020-00409-2.
Inflammatory response is activated during cardiopulmonary bypass (CPB), which may lead to acute respiratory distress syndrome (ARDS) and procalcitonin (PCT) increases during this inflammatory response. The objective of the study was to validate whether patients with higher serum PCT concentrations have a higher incidence of ARDS.
The study was a prospective, single-center, observational cohort study. All patients who received cardiac surgery with CPB were screened for study eligibility. Patients were assigned to the PCT-elevated cohort or the control cohort according to serum PCT concentration on the first postoperative day with a cut-off value of 7.0 ng/mL. Patients were followed up until the 7th postoperative day. The primary endpoint was the incidence of ARDS, which was diagnosed according to the Berlin definition.
A total of 296 patients were enrolled, 64 patients were assigned to the PCT-elevated cohort and 232 patients were assigned to the control cohort. PCT concentration was 16.23 ± 5.9 ng/mL in the PCT-elevated cohort, and 2.70 ± 1.43 ng/mL in the control cohort (p < 0.001). The incidence of ARDS was significantly higher in the PCT-elevated cohort than in the control cohort (21.9% versus 5.6%, p < 0.001). The incidence of moderate-to-severe ARDS was also significantly higher in the PCT-elevated cohort than in the control cohort (10.9% versus 0.4%, p < 0.001). The hazard ratio of ARDS at 7 days in the PCT-elevated cohort, as compared with the control cohort, was 6.8 (95% confidence interval 2.7 to 17.4). The hazard ratio of moderate-to-severe ARDS in the PCT-elevated cohort was 57.3 (95% confidence interval 10.4 to 316.3). The positive predictive value of PCT for ARDS and moderate-to-severe ARDS were 0.242 and 0.121, respectively; the negative predictive value of PCT for ARDS and moderate-to-severe ARDS were 0.952 and 1.0, respectively.
Cardiac surgical patients with elevated PCT concentration have a higher incidence of ARDS. Elevated PCT may serve as a warning signal of postoperative ARDS in patients undergoing cardiac surgery with CPB. Study registration Chinese Clinical Trial Registry (ChiCTR-OCH-14005076).
炎症反应在体外循环（CPB）期间被激活，这可能导致急性呼吸窘迫综合征（ARDS），并且在炎症反应期间降钙素原（PCT）增加。本研究的目的是验证血清 PCT 浓度较高的患者是否ARDS 发生率更高。
本研究是一项前瞻性、单中心、观察性队列研究。所有接受 CPB 心脏手术的患者均接受研究入选筛查。根据术后第 1 天的血清 PCT 浓度将患者分为 PCT 升高组或对照组，截断值为 7.0ng/mL。患者随访至术后第 7 天。主要终点是根据柏林定义诊断的 ARDS 发生率。
共纳入 296 例患者，其中 64 例患者被纳入 PCT 升高组，232 例患者被纳入对照组。PCT 升高组的 PCT 浓度为 16.23±5.9ng/mL，对照组为 2.70±1.43ng/mL（p<0.001）。PCT 升高组 ARDS 发生率明显高于对照组（21.9%比 5.6%，p<0.001）。PCT 升高组中中重度 ARDS 的发生率也明显高于对照组（10.9%比 0.4%，p<0.001）。与对照组相比，PCT 升高组第 7 天 ARDS 的风险比为 6.8（95%置信区间 2.7 至 17.4）。PCT 升高组中重度 ARDS 的风险比为 57.3（95%置信区间 10.4 至 316.3）。PCT 对 ARDS 和中重度 ARDS 的阳性预测值分别为 0.242 和 0.121，阴性预测值分别为 0.952 和 1.0。
PCT 浓度升高的心脏外科患者 ARDS 发生率较高。升高的 PCT 可能是 CPB 心脏手术后患者术后 ARDS 的预警信号。研究注册中国临床试验注册中心（ChiCTR-OCH-14005076）。
