British Journal of Anaesthesia, Vol 83, Issue 4 602-607, Copyright © 1999 by The Board of Management and Trustees of the British Journal of Anaesthesia
A. Aouifi, V. Piriou, P. Blanc, H. Bouvier, O. Bastien, P. Chiari, R. Rousson, R. Evans and J. J. Lehot
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) (n = 12);
group 2, CABG without CPB (n = 12); and group 3, valvular surgery with CPB
(n = 12). 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 (n = 19) and those without
SIRS (n = 17). 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) (P = 0.005). Samples for PCT and CRP measurements were obtained from
10 other patients with postoperative complications (circulatory failure n =
7; active endocarditis n = 2; septic shock n = 1). 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.
CLINICAL INVESTIGATIONS
Effect of cardiopulmonary bypass on serum procalcitonin and C-reactive protein concentrations
Service d'Anesthesie-Reanimation and EA 1896, Universite Claude Bernard, Lyon I, France; Laboratoire de Biochime, Hopital Cardiovasculaire et Pneumologique L. Pradel, Lyon, France; Nuffield Department of Anaesthetics, Radcliffe Infirmary, Oxford OX2 6HE, UK
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