Nadziakiewicz Paweł, Grochla Marek, Krauchuk Alena, Pióro Anna, Szyguła-Jurkiewicz Bożena, Baca Aleksandra, Zembala Michał O, Przybyłowski Piotr
Department of Cardiac Anesthesia and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Department of Cardiac Anesthesia and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Transplant Proc. 2020 Sep;52(7):2087-2090. doi: 10.1016/j.transproceed.2020.02.117. Epub 2020 Apr 16.
Procalcitonin (PCT) is a biomarker of systemic infection. Specificity of PCT is decreased because PCT is also elevated after heart transplantation (HTx). There is no established normal range of serum PCT concentrations after HTx yet. Our aim was to determine the course of PCT concentrations in patients after HTx in the early postoperative period, if we can discriminate postoperative increase in values from infectious complications.
Of 39 patients we diagnosed infection in 11. These patients develop acute kidney injury significantly more often than in control group (group C) (5 in infection group [group I] and 2 in group C, P < .05), and 1 patient died within 30 days in group C. Seven patients developed primary graft dysfunction (3/4 + ECMO [extracorporeal membrane oxygenation], respectively, group I/group C) and 2 neurologic disorders in group I. Reoperation due to bleeding was 3 in each group. During the 14 days after HTx, serum PCT concentrations increased with maximum on the second postoperative day (group C: 30.6 ± 15.3 ng/mL; group I: 24.9 ± 44.3 ng/mL). Normal values for PCT were reached on day 8 in group C and 11 in group I. Mean PCT levels were similar: 8.7 ± 5.7 ng/mL vs 11.9 ± 13.1 ng/mL in group I vs group C, respectively. Patients in group I stayed longer in the intensive care unit.
Despite increase in serum concentration of PCT in early postoperative course after HTx there is no marker of infection. Trends in PCT serum concentration may be a valuable tool in diagnosis of infection in patients after HTx, but further investigation is needed.
降钙素原（PCT）是全身感染的生物标志物。由于心脏移植（HTx）后PCT也会升高，其特异性降低。目前尚无HTx后血清PCT浓度的既定正常范围。我们的目的是确定HTx术后早期患者PCT浓度的变化过程，以及能否区分术后数值升高与感染并发症。
39例患者中，11例被诊断为感染。这些患者发生急性肾损伤的频率明显高于对照组（C组）（感染组[I组]5例，C组2例，P <.05），C组有1例患者在30天内死亡。I组有7例发生原发性移植功能障碍（分别为3/4 +体外膜肺氧合[ECMO]，I组/C组），I组有2例发生神经系统疾病。每组因出血进行再次手术的均为3例。HTx术后14天内，血清PCT浓度升高，术后第二天达到最高（C组：30.6±15.3 ng/mL；I组：24.9±44.3 ng/mL）。C组在第8天、I组在第11天达到PCT正常值。平均PCT水平相似：I组和C组分别为8.7±5.7 ng/mL和11.9±13.1 ng/mL。I组患者在重症监护病房停留的时间更长。
尽管HTx术后早期血清PCT浓度升高，但尚无感染标志物。PCT血清浓度趋势可能是诊断HTx术后患者感染的有价值工具，但仍需进一步研究。
