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BJA Advance Access originally published online on September 3, 2004
British Journal of Anaesthesia 2004 93(5):639-644; doi:10.1093/bja/aeh246
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2004

High concentrations of N-BNP are related to non-infectious severe SIRS associated with cardiovascular dysfunction occurring after off-pump coronary artery surgery{dagger}

F. Kerbaul1,*, R. Giorgi2, C. Oddoze3, F. Collart4, C. Guidon1, P. J. Lejeune5, J. Villacorta1 and F. Gouin1

1 Département d'Anesthésie-Réanimation Adulte, Groupe Hospitalier de La Timone, 13385 Marseille Cedex 05, France. 2 LERTIM, Faculté de Médecine, 13385 Marseille Cedex 05, France. 3 Laboratoire de Biochimie, Hôpital sainte Marguerite, 13009 Marseille, France. 4 Service de Chirurgie Cardiaque, Groupe Hospitalier de La Timone, 13385 Marseille Cedex 05, France. 5 Biochimie Endocrinienne et Métabolique/INSERM U 38, Faculté de Médecine Timone,13385 Marseille Cedex 05, France

* Corresponding author. E-mail: fkerbaul{at}yahoo.fr

Background. Procalcitonin (PCT) blood concentrations are known to be an appropriate marker of severe systemic inflammatory response syndrome (SIRS) induced by coronary artery surgery with and without cardiopulmonary bypass. Pro-brain natriuretic peptide (N-BNP) is a newly described cardiac hormone considered to be an effective marker of severity and prognosis of acute coronary syndromes and congestive heart failure. We evaluated the perioperative time courses of PCT and N-BNP and investigated their role as early markers of severe SIRS (SIRS with cardiovascular dysfunction) induced by off-pump coronary artery bypass (OPCAB).

Methods. Sixty-three patients were prospectively included. The American College of Chest Physicians Classification was used to diagnose SIRS and organ system failure to define severe SIRS. Serum concentrations of PCT and N-BNP were determined before, during and after surgery. Receiver operating characteristic curves and cut-off values were used to assess the ability of these markers to predict postoperative severe SIRS.

Results. SIRS occurred in 25 (39%) patients. Nine of them (14%) showed severe SIRS. Significantly higher serum concentrations of N-BNP and PCT were found in patients with severe SIRS with peak concentrations respectively at 8887 pg ml–1 (range 2940–29372 pg ml–1) for N-BNP and 9.50 ng ml–1 (range 1–65 ng ml–1) for PCT. The area under the curve using N-BNP to detect postoperative severe SIRS was 0.799 before surgery (0.408 for PCT; P<0.01) and 0.824 at the end of surgery (0.762 for PCT; P<0.05).

Conclusions. N-BNP may be an appropriate marker indicating the early development of non-infectious postoperative severe SIRS after OPCAB.

{dagger} This article is accompanied by Editoral II.


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