PROCALCITONIN AS A PREDICTIVE BIOMARKER AFTER OPEN HEART SURGERY

Abstract

Posternotomy infections are a serious complication and are directly related to patients’ survival in the short and long term. Despite prevention, their expression is still significant - from 0.5% to 6.8%, and the associated hospital mortality rates ranges from 7% to 35%. Procalcitonin (PCT) is a well-known prognostic marker after elective cardiac surgery. However, the impact of elevated PCT in patients with an initially uneventful postoperative course is still unclear. Purpose: to evaluate procalcitonin levels as a prognostic tool for delayed complications after open cardiac surgery – superficial and deep wound infections, SIRS, sepsis. Methods. In this prospective study, for the period July 2017 - February 2018, we evaluated 137 elective coronary patients in order to analyze the prognostic value of procalcitonin. Preoperative assessment of left ventricular function (EF) and operative risk (EuroSCORE) was performed. Patients with clinical and laboratory evidence of infection - fever, leukocytosis, toxicoinfectious syndrome and elevated CRP were excluded from the study. PCT was measured 24 hours after the intervention. Patients were followed up within 3 months and postoperative results were evaluated. Results. Among 137 patients with an initially uneventful postoperative course, 19 patients developed delayed complications. Serum PCT levels on the first postoperative day were significantly higher in these patients compared to the remaining. ROC analyses showed that PCT had a high accuracy to predict delayed complications (AUC of 0.90, sensitivity 83% and specificity 97%). Patients with PCT levels above 2 ng/ml on the first postoperative day had a highly increased risk of superficial and deep wound infections, SIRS and sepsis. Conclusion. A single measurement of PCT seems to be a useful tool to identify patients at risk of delayed complications despite an initially uneventful postoperative course.