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Table 1
Studies reporting perioperative PCT levels in patients undergoing cardiac surgery
Reference	Year	n	Age group	Disease group	PCT assay used and other markers	Results

[66]	1997	48	Adults	Heart transplantation	LUMI-Test	PCT levels were elevated after transplantation and decreased in uncomplicated postoperative course. No PCT elevation was observed with acute graft rejection. Steroid administration in patients with acute rejection had no influence on PCT levels.
[64]^a	1998	78	Adults	Heart, lung and heart, and lung transplantation	LUMI-Test CRP WBC count	PCT levels were similar between patients with acute graft rejection and non-infected patients. PCT levels were higher in local or systemic infection than rejection. CRP and WBC count were elevated equally in all groups. At discharge, PCT was higher in infected than non-infected patients. At discharge, CRP and WBC count were similar in all groups.
[29]	1998	57	Adults	MIDCAB versus CABG, with uneventful postoperative course	LUMI-Test CRP WBC count	PCT levels were elevated after surgical procedure in both groups and were higher in CABG versus MIDCAB. CRP levels were similar between CABG and MIDCAB. WBC count was elevated postoperatively in CABG versus MIDCAB.
[59]	1998	40	Adults	CABG with ECC ± aprotinin CABG with bacterial infection CABG with SIRS/no infection	LUMI-Test CRP	PCT levels were similar in patients who received aprotinin compared with the control group. PCT levels were less than 0.5 ng/ml at all time points but were higher in bacterial infection versus SIRS. CRP levels were similar in bacterial infection and SIRS.
[35]	1999	59	Adults	CPB; systemic or local infection or control	LUMI-Test CRP	PCT levels increased in all groups, peaked at 24 hours, remained high in patients with systemic infection, and normalised in others. CRP levels increased, peaked at 24 to 48 hours, and remained high in all groups; systemic infection > local infection > control group. PCT levels correlated with CRP levels only in infected patients. PCT: cut-off 4 ng/ml, sensitivity 86%, specificity 98% in predicting infection. CRP: cut-off 180 mg/l, sensitivity 100%, specificity 75% in predicting infection.
[36]	1999	36	Adults	CABG ± CPB; CABG	LUMI-Test CRP	PCT levels increased in the first 4 days, peaked on day 1, and were higher in patients with SIRS than no-SIRS. CRP levels peaked on day 1 and remained high through day 8. After valvular surgery on day 2, CRP levels were similar in patients with SIRS and no-SIRS. No correlation was observed between PCT levels and duration of CPB, aortic clamping, mechanical ventilation, or ICU stay. No correlation was observed between PCT and CRP levels in no-complication group.
[58]^a	2000	78	Adults	Heart, lung and heart, and lung transplantation	LUMI-Test CRP WBC count	PCT levels were higher in systemic than local infection than rejection than no rejection. PCT levels remained within normal limits in patients with acute graft rejection. CRP levels were equally elevated in all groups. WBC count was similar in all groups.
[37]	2000	74	Adults	CABG/HTx	LUMI-Test CRP WBC count ESR	CABG: PCT levels in sepsis > SIRS > no infection. Patients with no infection had a minimal rise (always less than 0.3 μg/ml) in PCT. Patients with SIRS also had high PCT levels. PCT peaked at 24 hours and normalised in 7 days all patients. HTx: PCT levels were higher in bacterial and fungal infection versus others; CRP was also high in bacterial and fungal infections.
[38]	2000	400	Adults	CPB	LUMI-Test CRP WBC count	WBC count peaked on day 1 in non-infected patients and on day 2 in infected patients (peak 14,000/μl). CRP levels peaked on day 2 in both groups and decreased but did not normalise (infection > no infection). PCT levels peaked on day 1 (infection > no infection) but peaked again on day 6 in infected patients.
[39]	2000	131	Adults	CPB Postoperative infection Septic versus cardiogenic shock	LUMI-Test CRP	PCT levels peaked on day 1, returned to normal values on day 3, and were higher in infected versus non-infected patients. PCT levels correlated to SAPS II score. PCT in patients with septic shock was always greater than 10 ng/ml. CRP levels were high in all patients and did not correlate to PCT. PCT levels were similar in Gram-positive versus Gram-negative infection. PCT levels were higher in septic versus cardiogenic shock. PCT: cut-off 1 ng/ml, sensitivity 85%, specificity 95% in predicting infection. CRP: cut-off 150 mg/l, sensitivity 64%, specificity 84% in predicting infection.
[40]	2000	722	Adults	CPB	LUMI-Test CRP WBC count	PCT levels increased over the first 24 hours; valvular > aortic > CABG. PCT levels were greater in non-survivors versus survivors.
[54]	2000	110	Adults	Cardiac surgery	LUMI-Test CRP WBC count TTR Iron	PCT did not change in patients with uncomplicated postoperative course and was similar in MIDCAB and open surgery. CRP levels peaked on POD 3. CRP levels were similar in minor and major infected patients. WBC count peaked on POD 2. TTR decreased postoperatively, reaching a nadir on PODs 3 and 4. Iron decreased postoperatively, was at its lowest value on POD 2, and was similar in all groups.
[63]	2000	42	Adults	CPB	LUMI-Test Neopterin NO metabolites	PCT levels were higher in complicated than uncomplicated CPB course on PODs 1 and 2. Neopterin was higher in complicated than uncomplicated CPB course. NO metabolites were higher in complicated than uncomplicated CPB course during ECC and on POD 1. PCT cut-off 0.15 ng/ml, positive predictive value 67%, and negative predictive value 82% in predicting postoperative complications.
[65]	2001	110	Adults	Heart, lung, or liver transplantation	LUMI-Test SAA CRP	PCT levels had higher predictive value for bacterial or fungal infection than SAA or CRP. Peak PCT, SAA, and CRP levels were higher in bacterial or fungal infection than viral infection or acute rejection. Peak PCT and SAA levels were slightly higher in patients with viral infection than in those after uneventful course.
[49]	2001	37	Children	Elective repair of congenital heart disease with CPB	LUMI-Test Troponin I (TnI) CK	TnI and CK were higher in cross-clamping time (CCT) greater than 80 minutes versus less than 80 minutes and in ventriculotomy versus atriotomy. PCT levels were higher in CCT greater than 80 minutes versus less than 80 minutes and in ventriculotomy versus atriotomy.
[41]	2001	24	Adults	MODS after CPB	LUMI-Test CRP IL-6 LBP	CRP and LBP levels were similar between study groups irrespective of MODS. IL-6 levels were higher in MODS than SIRS in the first 4 postoperative days. PCT levels were higher in patients with MODS than in those with SIRS. PCT/LPB was higher in patients with MODS with infection than MODS without infection.
[42]	2001	33	Adults	Cardiac surgery and perioperative myocardial infarction (PMI)	LUMI-Test CRP	PCT levels started to rise after CPB, peaked within 24 hours postoperatively, and decreased after 48 hours. CRP levels peaked after 48 hours and remained elevated after 72 hours. PCT levels were higher in PMI versus no PMI postoperatively and correlated to TnI.
[43]	2002	40	Adults	CABG with CPB; dopexamine, epidural anaesthesia, or control	LUMI-Test CRP WBC count TNF Human soluble ICAM-1	PCT/CRP/WBC count was elevated 4 and 18 hours after CPB. PCT levels were lower in patients receiving dopexamine and epidural versus control after 4 and 18 hours. WBC count was lower in dopexamine versus control at 4 hours after CPB. TNF levels were elevated in control 30 minutes after CPB versus baseline and returned to baseline after 18 hours.
[50]	2002	20	Children	Tetralogy of Fallot (TOF)	LUMI-Test CRP IL-6 IL-10	IL-6 levels were elevated in TOF versus healthy infants and preoperatively were higher in TOF versus VSD/AVC. IL-10 levels were lower in TOF versus VSD/AVC preoperatively and during CPB. CRP levels were lower in TOF versus VSD/AVC 24 hours after CPB. PCT levels were elevated after CPB in TOF versus VSD/AVC.
[44]	2002	63	Adults	CABG surgery with CPB with SIRS, severe SIRS, and control	LUMI-Test CRP WBC count	WBC count was similar between sepsis syndromes. CRP levels were higher in SIRS and severe SIRS versus control, with no difference between SIRS and severe SIRS. PCT levels were higher postoperatively in severe SIRS versus SIRS/control, with no difference between SIRS and no SIRS.
[45]	2002	208	Adults	Elective cardiovascular surgery	LUMI-Test CRP Lactate	PCT levels were higher in patients with postoperative complications. PCT, but not CRP, levels correlated with APACHE, SOFA, lactate, duration of ECC, duration of surgery, and ICU stay. PCT: cut-off 2 ng/ml, sensitivity 83.3%, specificity 75.2% in predicting infections.
[67]	2002	40	Adults	ECC + CABG	LUMI-Test WBC count Elastase AT III	PCT levels did not change perioperatively.
[62]^a	2003	454	Adults	CABG	LUMI-Test Albumin Euroscore COD	In multivariate analysis, serum albumin was associated with poorer outcome than PCT. PCT greater than 2.8 ng/ml discriminated non-survivors.
[55]	2003	28	Adults	CPB	LUMI-Test IL-6, IL-8, IL-18, IL-10, TGF-β	PCT/IL-8/IL-18 levels were higher in non-survivors. (IL-6, IL-10, and TGF-β were not.)
[46]	2003	25	Children	CPB	LUMI-Test CRP IL-6	PCT levels typically peaked at 24 hours and normalised postoperatively after day 5. CRP levels peaked at day 3 and remained elevated. IL-6 peaked at 6 hours and remained elevated. Peak PCT (not CRP/IL-6) levels correlated with duration of CPB, duration of aortic cross-clamping, days of intubation, and ICU days. Only PCT levels were higher in complicated cases.
[47]^b	2003	5	Adults	Aa disc	LUMI-Test CRP WBC count	PCT levels were higher preoperatively and peaked at 24 hours (likewise CRP). WBC count continued to rise at 48 hours.
[57]	2003	80	Adults	CABG with APACHE II > 20	LUMI-Test	PCT was higher in non-survivors than survivors, in infected than non-infected patients, and in complicated than uncomplicated cases. PCT greater than 5 ng/ml had a sensitivity of 81.5% and a specificity of 45.3% in predicting infection. PCT greater than 10 ng/ml had a sensitivity of 72.2% and a specificity of 51% in discriminating non-survivors.
[68]	2004	63	Adults	OPCAB	LUMI-Test N-BNP	N-BNP/PCT levels were higher in severe SIRS > SIRS > others.
[48]^a	2004	37	Children	Surgery for congenital heart disease	LUMI-Test IL-6	IL-6 levels increased postoperatively 50-fold independent of CCT, peaked within 24 hours after surgery, and were similar according to CCT, surgical technique, and CBT over the study period. PCT levels postoperatively were higher in CCT greater than 80 minutes versus less than 80 minutes, in ventriculotomy versus atriotomy, and in CBT below 22°C versus above 22°C.
[32]	2004	14	Children	Surgery for congenital heart disease with CPB	LUMI-Test CRP	PCT levels were higher after CPB than preoperative. PCT level peaked on POD 1 and decreased on POD 2. CRP levels were higher after CPB than preoperatively. CRP levels peaked just after CPB and remained high on POD 3.
[33]	2005	32	Adults	Elective CABG	LUMI-Test CRP WBC count	Baseline PCT levels were similar with uncomplicated and complicated postoperative course but peaked at 48 hours in complicated cases, reaching higher levels than uncomplicated cases. CRP/WBC count showed similar kinetics irrespective of the presence of complications.
[34]	2005	108	Adults	Elective thoracic (TC) and cardiac surgery (CABG + CPB/OPCAB)	LUMI-Test IL-6 IL-8 TNF-α CRP LBP IL-2R	IL-6 levels increased postoperatively and were similar in all groups. IL-8 levels increased postoperatively in OPCAB and CABG but not after TC. TNF levels increased postoperatively in OPCAB and TC but not in CABG. CRP and LBP levels increased postoperatively and peaked by the third day. PCT levels peaked after 24 hours and normalised within 5 days but were higher in CABG versus OPCAB. IL-2R levels increased postoperatively and peaked within 3 days.
[31]	2006	53	Children	Elective cardiac surgery ± CPB	LUMI-Test	PCT levels were higher in POD 1 to POD 3 versus baseline. No correlation was observed between PCT levels and bypass duration. In patients with CPB, postoperative PCT values were greater than 1 ng/ml. In patients without CPB, postoperative PCT was less than 1 ng/ml.
[30]	2006	33	Children	Cardiac surgery ± CPB	Kryptor CRP WBC count	PCT levels were higher in SIRS + organ failure than SIRS alone after surgery. PCT levels peaked on POD 1 and decreased until POD 4. CRP levels were similar between SIRS + organ failure and SIRS alone. CRP levels peaked on POD 2. WBC count was similar in SIRS + organ failure and SIRS alone until POD 3, then higher in SIRS + organ failure than SIRS alone. Peak PCT level correlated to ACC, duration of CPB, mechanical ventilation, ICU and hospital stay, mortality, and organ failure development. Peak PCT level of 0.7 ng/ml had a sensitivity of 85% and a specificity of 58% in predicting organ failure. Peak PCT level of 7.7 ng/ml had a sensitivity of 100% and a specificity of 100% in predicting organ failure. Peak PCT level of 5 ng/ml had a sensitivity of 100% and a specificity of 65% in predicting mortality. Peak PCT level of 34.2 ng/ml had a sensitivity of 100% and a specificity of 90% in predicting infection.

^aRetrospective study; ^bcase report. Aa disc, dissection of the aortic artery; APACHE, acute physiology and chronic health evaluation; AT III, antithrombin III; CABG, coronary artery bypass grafting; CBT, coronary artery bypass time; CK, creatine kinase; COD, colloid osmotic pressure; CPB, cardiopulmonary bypass; CRP, C-reactive protein; ECC, extracorporeal circulation; ESR, erythrocyte sedimentation rate; HTx, heart transplantation; ICAM-1, intercellular adhesion molecule-1; ICU, intensive care unit; IL, interleukin; LPB, lipopolysaccharide binding protein; MIDCAB, minimally invasive coronary artery bypass; MODS, multiorgan dysfunction syndrome; N-BNP, pro-brain natriuretic peptide; NO, nitric oxide; OPCAB, off-pump coronary artery bypass; PCT, procalcitonin; POD, postoperative day; SAA, serum amyloid A; SAPS, simplified acute physiology score; SIRS, systemic inflammatory response syndrome; SOFA, sequential organ failure assessment; TGF-β, transforming growth factor-beta; TNF, tumour necrosis factor; TTR, transthyretin; VSD/AVC, ventricular septal defect/atrioventricular conduit; WBC, white blood cell.
Sponholz et al. Critical Care 2006 10:R145 doi:10.1186/cc5067

Table 1