Assessment of the accuracy of procalcitonin to diagnose postoperative infection after cardiac surgery

• Published in: Anesthesiology (Philadelphia) 2007-08, Vol.107 (2), p.232-238
• Main Authors: MOHAMED ADEL JEBALI, HAUSFATER, Pierre, ABBES, Zoubeir, AOUNI, Zied, RIOU, Bruno, FERJANI, Mustapha
• Format: Article
• Language: English
• Subjects: Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bacterial Infections - blood; Bacterial Infections - diagnosis; Biological and medical sciences; Biomarkers - blood; C-Reactive Protein; Calcitonin - blood; Calcitonin Gene-Related Peptide; Cardiopulmonary Bypass - adverse effects; Elective Surgical Procedures - methods; Female; Humans; Interleukin-6 - blood; Interleukin-8 - blood; Leukocyte Count - methods; Male; Medical sciences; Middle Aged; Postoperative Complications - blood; Postoperative Complications - diagnosis; Predictive Value of Tests; Prospective Studies; Protein Precursors - blood; Reproducibility of Results; ROC Curve; Sensitivity and Specificity; Time Factors
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/01.anes.0000271871.07395.ad

Cardiopulmonary bypass induces a nonspecific inflammatory response. Procalcitonin has been advocated as a specific biomarker for infection. The authors studied the accuracy of procalcitonin to diagnose postoperative infection after cardiac surgery and compared it with those of C-reactive protein, white blood cell count, and interleukins 6 and 8. The authors prospectively included 100 patients scheduled to undergo elective cardiac procedures with cardiopulmonary bypass. Blood samples were taken before surgery and each day over the 7-day postoperative period, and measurement of procalcitonin, C-reactive protein, white blood cell count, and interleukins 6 and 8 were performed. Diagnosis of infection was performed by a blinded expert panel. Data are expressed as value [95% confidence interval]. Infection was diagnosed in 16 patients. Procalcitonin was significantly higher in infected patients, with a peak reached on the third postoperative day. Only the areas under the receiver operating curve of procalcitonin (0.88 [0.71-0.95]) and C-reactive protein (0.72 [0.58-0.82]) were significantly different from the no-discrimination curve, and that of procalcitonin was significantly different from those of C-reactive protein, white blood cell count, and interleukins 6 and 8. A procalcitonin value greater than 1.5 ng/ml beyond the second day diagnosed postoperative infection with a sensitivity of 0.93 [0.70-0.99] and a specificity of 0.80 [0.70-0.87]. Procalcitonin was significantly higher in patients who died (27.5 [1.65-40.5] vs. 1.2 [0.7-1.5] ng/ml; P < 0.001). Procalcitonin is a valuable marker of bacterial infections after cardiac surgery.