Der infektionsmarker procalcitonin in der herzchirurgie

The use of extracorporal circulation in open heart surgery causes profound stimulation of proinflammatory reaction. Therefore, timely diagnosis of infectious complications may become extremely difficult, and a more reliable marker of sepsis under these circumstances is needed. We measured the new marker for sepsis Procalcitonin (PCT) in two distinct groups of patients exposed to extracorporeal circulatory devices. Group VAD consisted of 38 patients in end-stage heart failure supported with ventricular assist devices (VAD) Type Berlin Heart. Group EEC included 713 patients undergoing standard open heart surgery procedures. PCT was measured before operation and daily thereafter. PCT levels before operation were able to identify patients in cardiogenic shock who after device implantation died of infectious complications. Patients on VAD who showed elevated PCT levels before heart transplantation had a very unfavorable outcome. In the ECC group, none of the patients had elevated PCT levels before surgery. On day one after the procedure PCT was elevated in those patients who in their further postoperative course developed complications. Patients without PCT elevation after open heart surgery had an uncomplicated recovery. Under the conditions of cardiogenic shock as well as the use of extracorporeal circulation, PCT is able to identify bacterial and fungal infections. It is helpful in evaluating the transplantability of patients on VADs. PCT seams to be unaffected by the use of extracorporeal circulatory circuits. However, a substantial number of patients exhibit PCT increase after ECC, and the PCT level has some prognostic value. The increase of PCT may be due to intestinal malperfusion.