Effect of cardiopulmonary bypass on activated partial thromboplastin time waveform analysis, serum procalcitonin and C-reactive protein concentrations (original) (raw)
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Effect of cardiopulmonary bypass on serum procalcitonin and C-reactive protein concentrations
British Journal of Anaesthesia, 1999
We have measured serum procalcitonin (PCT) concentrations after cardiac surgery in 36 patients allocated to one of three groups: group 1, coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) (nϭ12); group 2, CABG without CPB (nϭ12); and group 3, valvular surgery with CPB (nϭ12). Serum PCT and C-reactive protein (CRP) concentrations were measured before operation, at the end of surgery and daily until postoperative day 8. Serum PCT concentrations increased, irrespective of the type of cardiac surgery, with maximum concentrations on day 1: mean 1.3 (SD 1.8), 1.1 (1.2) and 1.4 (1.2) ng ml -1 in groups 1, 2 and 3, respectively (ns). Serum PCT concentrations remained less than 5 ng ml -1 in all patients. Concentrations returned to normal by day 5 in all groups. To determine the effect of the systemic inflammatory response (SIRS) on serum PCT concentrations, patients were divided post hoc, without considering the type of cardiac surgery, into patients with SIRS (nϭ19) and those without SIRS (nϭ17). The increase in serum PCT was significantly greater in SIRS (peak PCT 1.79 (1.64) ng ml -1 vs 0.34 (0.32) ng ml -1 in patients without SIRS) (Pϭ0.005). Samples for PCT and CRP measurements were obtained from 10 other patients with postoperative complications (circulatory failure nϭ7; active endocarditis nϭ2; septic shock nϭ1). In these patients, serum PCT concentrations ranged from 6.2 to 230 ng ml -1 . Serum CRP concentrations increased in all patients, with no differences between groups. The postoperative increase in CRP lasted longer than that of PCT. We conclude that SIRS induced by cardiac surgery, with and without CPB, influenced serum PCT concentrations with a moderate and transient postoperative peak on the first day after operation. A postoperative serum PCT concentration of more than 5 ng ml -1 is highly suggestive of a postoperative complication.
Is C-Reactive Protein a Biomarker for Immediate Clinical Outcome After Cardiac Surgery?
Journal of Cardiothoracic and Vascular Anesthesia, 2009
The purpose of this study was to determine the possible correlation between inflammatory activation after cardiac surgery with cardiopulmonary bypass, measured by postoperative C-reactive protein concentrations, and immediate intensive care unit outcome. Design: A prospective, clinical cohort study. Setting: A 10-bed surgical intensive care unit at a tertiary university hospital. Patients: Two hundred sixteen consecutive patients undergoing nonemergency cardiac surgery with cardiopulmonary bypass. Measurements and Main Results: Parsonnet and Acute Physiology and Chronic Health Evaluation scores, characteristics of the surgical intervention, intensive care unit length of stay, and mortality were recorded along with the following variables: cardiac (hours requiring inotropic support and new atrial fibrillation), respiratory (oxygenation index and hours requiring intubation), renal (difference between serum creatinine at admission and maximum creatinine), and analytic (C-reactive protein at admission and 6, 24, and 48 hours later; troponin I; CK-MB; and lactate). Results: Postoperative C-reactive protein concentrations did not correlate with variables such as time requiring inotropic support or intubation, oxygenation index, delta serum creatinine, and intensive care unit length of stay (with the exception of cardiopulmonary bypass time and the more frequent norepinephrine requirement in patients with higher C-reactive protein concentration at 48 hours); nor did Creactive protein correlate with the analytic variables (with the exception of the lactate peak and C-reactive protein concentrations at 24 and 48 hours). There was no correlation between C-reactive protein and postoperative variables for coronary artery bypass graft surgery and valvular groups analyzed separately. Conclusion: Postoperative C-reactive protein does not seem to be a useful marker in predicting outcome after 48 hours in the intensive care unit.
Usefulness of procalcitonin for diagnosis of infection in cardiac surgical patients
Critical Care Medicine, 2000
fter cardiac surgery, infection is a major complication with serious impact on outcome and cost. In our institution in 1997, the overall infection rate in cardiac surgical patients reached 8%, including not only minor infections but also sepsis such as pneumonia, acute endocarditis, mediastinitis, and septic shock. One of the most important signals of the onset of infection is fever. Nevertheless, a body temperature Ͼ38°C related to the postoperative systemic inflammatory response syndrome (SIRS) is frequent after cardiac surgery in the absence of infection (1, 2) making this clinical variable nonspecific. C-reactive protein (CRP) is also nonspecific for infection during postoperative SIRS induced by cardiac surgery; serum CRP values increase during the postoperative period after cardiac surgery even in the absence of infection (3). Procalcitonin (PCT) is a precursor of calcitonin in humans (4). Usually undetectable in healthy subjects, it was proposed as an early, sensitive, and specific indicator of sepsis (5-8). Nevertheless, an increased serum PCT concentration has From the Service d'Anesthé sie-Ré animation and E.A 1896
Sepsis and identification of reliable biomarkers for postoperative period prognosis
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie, 2018
Sepsis is currently defined as the presence of organ dysfunction occurring as the result of a disturbed host response to a serious infection. Sepsis is one of the most common diseases, which cause mortality and a considerable absorber of healthcare resources. Despite progress in technology and improving knowledge of pathophysiology, the disease mechanism is still poorly understood. At present, diagnosis is based on non-specific physiological criteria and on the late identification of the pathogen. For these reasons, the diagnosis may be uncertain, treatment delayed or an immunomodulatory therapy cannot be established. An early and reliable diagnosis is essential to achieve better outcomes on disease progression. The host response to infection involves hundreds of many mediators of which have been proposed as biomarkers. There is a need for new diagnostic approaches for sepsis, new sepsis biomarkers that can aid in diagnosis, therapeutic decision and monitoring of the response to the...
Cytometry, 2003
Background: Cardiac surgery using cardiopulmonary bypass (CPB) may induce a systemic inflammatory response syndrome (SIRS), which is associated with an increased risk of postoperative morbidity and mortality. The intention of this pilot study was to investigate the influence of the pro-and anti-inflammatory cytokine responses as well as of released adhesion molecules and endotoxin on the time requirements for assisted postoperative respiration following CPB surgery.
Importance of Markers of Sepsis in Surgical Patients
The American Surgeon, 2018
Sepsis, severe sepsis, and septic shock represent a serious medicinal and general social problem and still maintain an important position among the present issues in the basic and clinical research. In the prospective analysis of patients satisfying the criteria of septic condition, we determined serum levels of bioparameters in three consecutive days from the first signs of sepsis depending on the stage or advancement of the septic condition. We determined the most significant parameter/parameters which are able to determine the stage of sepsis or to predict patient's death. In the group of 68 patients, all monitored biomarkers showed significant difference in serum concentrations versus the control group (P = 0.001). The strongest positive connection between the seriousness of sepsis and serum level is in case of procalcitonin. Predictor of mortality (r = -0.468; P = 0.001), transferrin (r = -0.506; P = 0.003), and tumor necrosis factor-α (r = 0.939; P = 0.001). Our results sh...