The prognostic value of elevated serum levels of procalcitonin (PCT) in patients early after cardiac operation on cardiopulmonary bypass (CPB) remains unclear and was therefore investigated in a prospective study.
Using a modified APACHE-II-score 39 patients (group I) at high risk and 20 patients (group II) at low risk were identified on the first postoperative day after cardiac surgery on CPB and hypothermic (26°C) cardioplegic (HTK-solution, 4°C, 15 ml/kg body weight) cardiac arrest. There were no differences regarding length of operation, CPB and aortic clamping time. While preoperative mortality reached 23%, infection rate 41% and complication rate 59% in group I, the postoperative course was uneventful in all but 2 patients (10%) in group II suffering from infections. PCT serum levels were measured (LUMItest®, Fa. Brahms) preoperatively (PCT0), at the 1. (PCT1), 2. (PCT2) and 5. (PCT5) postoperative day in all patients and analyzed with respect to infections, complications and perioperative mortality.
The mean PCT levels were significantly elevated in both groups early after surgery, however, they reached significant higher values in group I compared to group II (see Table 1):
In group I PCT1/2/5 were significantly increased in patients suffering from a complication, PCT2/5 in patients with an infection and PCT5 in patients who died perioperatively (see Table 2):
PCT serum levels are significantly elevated in patients early after cardiac surgery on CPB. Very high serum levels of PCT at the first postoperative day are predictors for the occurrence of complications, at the second postoperative day for a high incidence of infections and at the fifth postoperative day for a significantly worsened outcome.