降钙素原对非体外循环冠状动脉旁路移植术后肺部感染的早期预测价值。

Early Predictive Value of Procalcitonin for the Diagnosis of Pulmonary Infections after Off-pump Coronary Artery Bypass Grafting.

机构信息

Department of Cardiac Surgery,Peking University International Hospital, Beijing ,China.

Department of Adult Surgical Intensive Care Unit, Fuwai Hospital, Beijing, China.

出版信息

Heart Surg Forum. 2021 Jan 13;24(1):E004-E008. doi: 10.1532/hsf.3381.

DOI:10.1532/hsf.3381

PMID:33635256

Abstract

BACKGROUND

Cardiac surgery can cause similar inflammatory reactions with infection; antibacterial treatment may be inappropriately used. Early and accurate diagnosis of infection still is a difficult problem worldwide. Procalcitonin (PCT) helps to identify sepsis caused by bacterial infections. However, its application in the diagnosis of pulmonary infections after off-pump coronary artery bypass grafting (OPCABG) has not been well studied. We investigated the early predictive value of PCT for the diagnosis of pulmonary infections after OPCABG.

METHODS

We retrospectively analyzed the clinical data, including conditions in the intensive care unit, postoperative complications, mortality rate, plasma PCT in the morning on the first postoperative day, routine white blood cell (WBC) count, and high-sensitivity C-reactive protein (hs-CRP) levels of patients who underwent elective OPCABG. Patients were divided into an infection group and a noninfection group, according to the occurrence of pulmonary infections. A receiver operating characteristic (ROC) curve was used to analyze the predictive value of PCT for the diagnosis of postsurgical infections.

RESULTS

In total, 131 patients who underwent OPCABG were included, of whom 23 (17.6%) developed pulmonary infections. The plasma PCT level significantly was higher in the infection group than in the noninfection group (6.0 ± 6.3 ng/ml vs. 2.0 ± 2.2 ng/ml, P = 0.007). WBC and hs-CRP values were not significantly different between the infection group and the noninfection group (12.3 ± 3.9×109/L vs. 11.1 ± 2.8×109/L, P = 0.171 and 12.4 ± 0.7 mg/L vs. 12.4 ± 0.8 mg/L, P = 0.903, respectively). The area under the ROC for predicting pulmonary infections after OPCABG by plasma PCT was 0.783 (P < 0.001, with a 95% confidence interval of 0.674-0.893), with a cut-off value of 3.55 ng/ml, a sensitivity of 0.609, and a specificity of 0.861.

CONCLUSION

From our study results, we postulate that PCT has a high early predictive value for the diagnosis of pulmonary infections after OPCABG.

摘要

背景

心脏手术可引起类似的炎症反应与感染；抗菌治疗可能不适当的使用。早期和准确的诊断仍然是一个全球性的感染问题。降钙素原（PCT）有助于确定由细菌感染引起的败血症。然而，其在非体外循环冠状动脉旁路移植术（OPCABG）后肺部感染的诊断中的应用尚未得到很好的研究。我们研究了 PCT 对 OPCABG 后肺部感染的早期预测价值。

方法

我们回顾性分析了包括重症监护病房条件、术后并发症、死亡率、术后第一天早晨血浆 PCT、常规白细胞（WBC）计数和高敏 C 反应蛋白（hs-CRP）水平等临床资料的患者的临床数据，这些患者接受了选择性 OPCABG。根据是否发生肺部感染，患者被分为感染组和非感染组。采用受试者工作特征（ROC）曲线分析 PCT 对术后感染的诊断预测价值。

结果

共纳入 131 例行 OPCABG 的患者，其中 23 例（17.6%）发生肺部感染。感染组患者的血浆 PCT 水平明显高于非感染组（6.0±6.3ng/ml 比 2.0±2.2ng/ml，P=0.007）。感染组和非感染组的 WBC 和 hs-CRP 值无显著差异（12.3±3.9×109/L 比 11.1±2.8×109/L，P=0.171 和 12.4±0.7mg/L 比 12.4±0.8mg/L，P=0.903）。PCT 预测 OPCABG 后肺部感染的 ROC 曲线下面积为 0.783（P<0.001，95%置信区间为 0.674-0.893），截断值为 3.55ng/ml，灵敏度为 0.609，特异性为 0.861。