gms | German Medical Science

Introduction: A differentiation of SIRS and sepsis can be achieved by measurement of procalcitonin (PCT). Increased PCT-levels can only be detected in septic conditions, but not in patients suffering from inflammatory complications (SIRS). It was our aim to analyze whether any postoperative PCT-elevation is followed by a complicated course, particularly septic complications, and try to find a correlation to further perioperative biomarkers.

Materials and methods: In 2436 patients undergoing cardiac surgery between 2008 and 2010, postoperative blood samples for PCT-measurement were taken. At the same time CRP and leucocytes were determined in these patients.

Results: In 1754 patients (72 %) all PCT-values were less than 0.4 ng/ml (group A). Postoperative peak-levels between 0.4 and 1.0 ng/ml could be found in 365 patients (15 %) (group B) and between 1.0 and 10 ng/ml in 219 patients (9 %) (group C). In 98 patients (4 %) (group D) PCT-values of more than 10 ng/ml could be detected. 1.2 % of group A patients suffered from postoperative septic complications (B:3.8 %; C:6.1 %; D:85 %) (p<0.01 [D/A,B,C]). Additionally, there were significant differences with regard to postoperative catecholamine support (A:10.3 %, B:14.8 %, C:20.1 %, D:89.8 %) (p<0.01), for duration of mechanical ventilation (A:4.1 hours, B:7.2 h, C:16.6 h, D:57.3 h) (p<0.01) and for stay on ICU (A:1.5 days, B:1.7 d, C:2.7 d, D:7.9 d) (p<0.01). Values of CRP and leucocytes were not equally reliable to discriminate the groups, particularly peaks of PCT preceeded those of CRP and leucocytes.

Conclusion: Our results clearly showed that a postoperative PCT-elevation is not always a prognostic tool to predict an adverse outcome after cardiac surgery. However, the incidence of a sepsis rises with increasing PCT-levels. A PCT-value of more than 10 ng/ml is a reliable marker for ongoing sepsis