Assessment of the Accuracy of Procalcitonin to Diagnose Postoperative Infection after Cardiac Surgery

Author:

Jebali Mohamed Adel1,Hausfater Pierre2,Abbes Zoubeir1,Aouni Zied3,Riou Bruno4,Ferjani Mustapha5

Affiliation:

1. Staff Anesthesiologist, Department of Anesthesiology and Critical Care.

2. Staff Emergency Physician, Department of Emergency Medicine and Surgery.

3. Staff Pharmacist, Department of Pharmacy.

4. Professor of Anesthesiology and Critical Care and Chairman, Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire Pitié-Salpêtrière.

5. Professor of Anesthesiology and Critical Care and Chairman, Department of Anesthesiology and Critical Care, Military Hospital, Tunis.

Abstract

Background Cardiopulmonary bypass induces a nonspecific inflammatory response. Procalcitonin has been advocated as a specific biomarker for infection. The authors studied the accuracy of procalcitonin to diagnose postoperative infection after cardiac surgery and compared it with those of C-reactive protein, white blood cell count, and interleukins 6 and 8. Methods The authors prospectively included 100 patients scheduled to undergo elective cardiac procedures with cardiopulmonary bypass. Blood samples were taken before surgery and each day over the 7-day postoperative period, and measurement of procalcitonin, C-reactive protein, white blood cell count, and interleukins 6 and 8 were performed. Diagnosis of infection was performed by a blinded expert panel. Data are expressed as value [95% confidence interval]. Results Infection was diagnosed in 16 patients. Procalcitonin was significantly higher in infected patients, with a peak reached on the third postoperative day. Only the areas under the receiver operating curve of procalcitonin (0.88 [0.71-0.95]) and C-reactive protein (0.72 [0.58-0.82]) were significantly different from the no-discrimination curve, and that of procalcitonin was significantly different from those of C-reactive protein, white blood cell count, and interleukins 6 and 8. A procalcitonin value greater than 1.5 ng/ml beyond the second day diagnosed postoperative infection with a sensitivity of 0.93 [0.70-0.99] and a specificity of 0.80 [0.70-0.87]. Procalcitonin was significantly higher in patients who died (27.5 [1.65-40.5] vs. 1.2 [0.7-1.5] ng/ml; P < 0.001). Conclusion Procalcitonin is a valuable marker of bacterial infections after cardiac surgery.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Anesthesiology and Pain Medicine

Reference38 articles.

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