de la Varga-Martínez Olga, Martín-Fernández Marta, Heredia-Rodríguez María, Ceballos Francisco, Cubero-Gallego Hector, Priede-Vimbela Juan Manuel, Bardají-Carrillo Miguel, Sánchez-de Prada Laura, López-Herrero Rocío, Jorge-Monjas Pablo, Tamayo Eduardo, Gómez-Sánchez Esther
Department of Anaesthesiology, Infanta Leonor University Hospital, Gran Via del Este 80, 28031 Madrid, Spain.
BioCritic, Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain.
J Clin Med. 2022 Dec 7;11(24):7274. doi: 10.3390/jcm11247274.
Background: procalcitonin is a valuable marker in the diagnosis of bacterial infections; however, the impairment of renal function can influence its diagnostic precision. The objective of this study is to evaluate the differential behaviour of procalcitonin, as well as its usefulness in the diagnosis of postoperative pulmonary infection after cardiac surgery, depending on the presence or absence of impaired renal function. Materials and methods: A total of 805 adult patients undergoing cardiac surgery with extracorporeal circulation (CBP) were prospectively recruited, comparing the behaviour of biomarkers between the groups with and without postoperative pneumonia and according to the presence or absence of renal dysfunction. Results: Pulmonary infection was diagnosed in 42 patients (5.21%). In total, 228 patients (28.32%) presented postoperative renal dysfunction. Procalcitonin was significantly higher in infected patients, even in the presence of renal dysfunction. The optimal procalcitonin threshold differed markedly in patients with renal dysfunction compared to patients without renal dysfunction (1 vs. 0.78 ng/mL p < 0.05). The diagnostic accuracy of procalcitonin increased significantly when the procalcitonin threshold was adapted to renal function. Conclusions: Procalcitonin is an accurate marker of postoperative infection in cardiac surgery, even in the presence of renal dysfunction. Renal function is an important determinant of procalcitonin levels and, therefore, its diagnostic thresholds must be adapted in the presence of renal dysfunction.
降钙素原是细菌感染诊断中的一个重要标志物；然而，肾功能损害会影响其诊断准确性。本研究的目的是评估降钙素原在心脏手术后肺部感染诊断中的差异表现及其效用，取决于是否存在肾功能损害。材料与方法：前瞻性招募了805例接受体外循环心脏手术的成年患者，比较术后发生肺炎和未发生肺炎患者组之间生物标志物的表现，并根据是否存在肾功能不全进行比较。结果：42例患者（5.21%）被诊断为肺部感染。共有228例患者（28.32%）出现术后肾功能不全。即使存在肾功能不全，感染患者的降钙素原水平也显著更高。与无肾功能不全的患者相比，肾功能不全患者的降钙素原最佳阈值有显著差异（1 vs. 0.78 ng/mL，p < 0.05）。当降钙素原阈值根据肾功能进行调整时，其诊断准确性显著提高。结论：降钙素原是心脏手术后感染的一个准确标志物，即使存在肾功能不全。肾功能是降钙素原水平的一个重要决定因素，因此，在存在肾功能不全时，其诊断阈值必须进行调整。
