TY - JOUR
T1 - Procalcitonin in patients undergoing cardiopulmonary bypass in open heart surgery - First results of the procalcitonin in heart surgery study (ProHearts)
AU - Loebe, M.
AU - Locziewski, S.
AU - Brunkhorst, F. M.
AU - Harke, C.
AU - Hetzer, R.
N1 - Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2000
Y1 - 2000
N2 - Objective: To investigate procalcitonin (PCT) levels in patients undergoing cardiopulmonary bypass (CPB) in order to assess the prevalence and prognostic capacity of elevated PCT levels following CPB in open heart surgery. Design: prospective observational study in consecutive patients. Setting: Twenty-four-bed ICU, department of thoracic and cardiovascular surgery, university hospital. Patients: Seven hundred and twenty two patients, 691 of whom underwent CPB, i.e., 476 had coronary bypass surgery (CABG), 130 valve replacement, 34 combined CABG and valve replacement, and 23 thoracic aortic surgery. Interventions: Standard perfusion techniques were used with cardioplegic arrest and mild hypothermia (28-32 °C). With the exception of thoracic aortic procedures, full-flow perfusion was performed. Measurements and results: PCT was measured prior to surgery and daily thereafter until ICU discharge or death. PCT significantly increased at day 1 postoperatively compared to baseline values (0.25 ± 1.65 vs 6.49 ± 22.0 ng/ml, p < 0.005). However, in 55.1 % of patients PCT was below 1.0 ng/ml. In 12.8 % of CABG patients PCT was increased to > 5.0 ng/ml, compared to 39 % in valve patients and 35 % of patients with aortic surgery. An elevated PCT level > 1.0-5.0 ng/ml at day 1 was highly predictive of mortality (P < 0.03, vs < 1.0 ng/ml), with an additional accuracy when levels > 5.0 ng/ml were measured (P < 0.002 vs < 1.0 ng/ml). Conclusions: These results provide evidence that PCT might serve as an early prognostic marker in patients undergoing CPB in open heart surgery. It may be worth considering immunomodulating approaches in patients presenting elevated PCT levels in the early phase after CPB.
AB - Objective: To investigate procalcitonin (PCT) levels in patients undergoing cardiopulmonary bypass (CPB) in order to assess the prevalence and prognostic capacity of elevated PCT levels following CPB in open heart surgery. Design: prospective observational study in consecutive patients. Setting: Twenty-four-bed ICU, department of thoracic and cardiovascular surgery, university hospital. Patients: Seven hundred and twenty two patients, 691 of whom underwent CPB, i.e., 476 had coronary bypass surgery (CABG), 130 valve replacement, 34 combined CABG and valve replacement, and 23 thoracic aortic surgery. Interventions: Standard perfusion techniques were used with cardioplegic arrest and mild hypothermia (28-32 °C). With the exception of thoracic aortic procedures, full-flow perfusion was performed. Measurements and results: PCT was measured prior to surgery and daily thereafter until ICU discharge or death. PCT significantly increased at day 1 postoperatively compared to baseline values (0.25 ± 1.65 vs 6.49 ± 22.0 ng/ml, p < 0.005). However, in 55.1 % of patients PCT was below 1.0 ng/ml. In 12.8 % of CABG patients PCT was increased to > 5.0 ng/ml, compared to 39 % in valve patients and 35 % of patients with aortic surgery. An elevated PCT level > 1.0-5.0 ng/ml at day 1 was highly predictive of mortality (P < 0.03, vs < 1.0 ng/ml), with an additional accuracy when levels > 5.0 ng/ml were measured (P < 0.002 vs < 1.0 ng/ml). Conclusions: These results provide evidence that PCT might serve as an early prognostic marker in patients undergoing CPB in open heart surgery. It may be worth considering immunomodulating approaches in patients presenting elevated PCT levels in the early phase after CPB.
KW - Cardiopulmonary bypass
KW - Coronary artery bypass graft
KW - Endotoxin
KW - Hypotension
KW - Procalcitonin
KW - Prognosis
KW - Systemic inflammatory response syndrome (SIRS)
KW - Thoracic aortic surgery
KW - Valve surgery
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U2 - 10.1007/bf02900737
DO - 10.1007/bf02900737
M3 - Article
C2 - 18470719
AN - SCOPUS:0034070189
VL - 26
SP - S193-S198
JO - Intensive Care Medicine, Supplement
JF - Intensive Care Medicine, Supplement
SN - 0935-1701
IS - 2
ER -