Department of Anaesthesiology, Yamagata University Faculty of Medicine, Yamagata, Japan.
Cancer Prevention and Cancer Control Division, Kanagawa Cancer Center Research Institute, Yokohama, Japan.
Anaesthesiol Intensive Ther. 2021;53(3):215-222. doi: 10.5114/ait.2021.108159.
Postoperative infection remains a serious complication of cardiac surgery; however, no existing biomarkers can detect infection in the early perioperative period. We investigated the usefulness of presepsin, a novel biomarker, in predicting postoperative infectious complications in cardiac surgery with cardiopulmonary bypass.
For patients aged > 18 years who underwent elective cardiac surgery with cardiopulmonary bypass between 2015 and 2017, data of clinical features, perioperative presepsin levels, and infectious complications were collected. We compared the perioperative presepsin levels between the infected and non-infected groups, performed a risk factor analysis for postoperative infection, and calculated the cut-off value of presepsin with postoperative infection.
Among the 73 included patients, 20 developed postoperative infectious complications. The presepsin levels pre-operatively and on post-operative day (POD) zero were significantly higher in the infected than in the non-infected group (145.2 vs. 93.2, 514.0 vs. 328.1 [pg mL-1], p < 0.05, respectively). The odds ratio (OR) for postoperative infection included pre-operative presepsin (OR; 1.22 [confidence interval; 1.07-1.40]/10 pg mL-1) and presepsin on POD zero (OR; 1.31 [confidence interval; 1.05-1.64] /100 pg mL-1). The cut-off predictive values for postoperative infectious complications of pre-operative presepsin and on POD zero were 132 and 347 [pg mL-1], respectively.
Perioperative presepsin levels could be an early predictor for postoperative infectious complications in cardiac surgery.
术后感染仍然是心脏手术的严重并发症；然而，目前没有生物标志物能够在围手术期早期检测到感染。我们研究了一种新型生物标志物——降钙素原前体（presepsin）在体外循环心脏手术中预测术后感染性并发症的作用。
对 2015 年至 2017 年间接受体外循环心脏择期手术的>18 岁患者，收集其临床特征、围手术期降钙素原前体水平和感染性并发症的数据。我们比较了感染组和非感染组患者的围手术期降钙素原前体水平，对术后感染的危险因素进行了分析，并计算了降钙素原前体对术后感染的截断值。
在 73 例纳入患者中，20 例发生术后感染性并发症。感染组患者术前和术后第 0 天的降钙素原前体水平显著高于非感染组（145.2 vs. 93.2，514.0 vs. 328.1 [pg/ml]，p<0.05）。术后感染的比值比（OR）包括术前降钙素原前体（OR；1.22 [置信区间；1.07-1.40]/10 pg/ml）和术后第 0 天的降钙素原前体（OR；1.31 [置信区间；1.05-1.64] /100 pg/ml）。术前降钙素原前体和术后第 0 天的术后感染的截断值预测值分别为 132 和 347 [pg/ml]。
围手术期降钙素原前体水平可能是心脏手术后术后感染性并发症的早期预测指标。
