Procalcitonin and Postoperative Outcome After Open-heart Surgery
Condition: Open Heart Surgery; Cardiopulmonary Bypass; Procalcitonin; C-reactive Protein; Lactate; Outcome; Postoperative Complications
MeSH terms: Postoperative Complications
Study type: Observational [Patient Registry]

Summary: 
      The aim of this study was to investigate the impact of serum values of procalcitonin (PCT),
      C-reactive protein (CRP) and lactate to predict postoperative complications in the early
      postoperative period after open-heart surgery with cardiopulmonary bypass (CPB).
    

Detailed description: 
      The cardiopulmonary bypass (CPB) causes an inflammatory response secondary to the activation
      of cytokine systems in the whole body. The causes of this inflammation have been discussed
      extensively in the literature. As a concise summary the causes can be listed as; 1- the
      surgical stress, 2- the recognition of bypass circuit as an artificial surface by the blood
      components, 3- ischemia-reperfusion injury, 4- endotoxemia. After open-heart surgery with
      CPB, the development of several postoperative complications including myocardial dysfunction,
      respiratory failure, renal and neurologic dysfunction, bleeding disorders, altered liver
      function, and, multiple organ failure has been demonstrated to be related to the inflammatory
      response. Procalcitonin (PCT), is a 116-amino-acid protein that is produced in the liver and
      peripheral mononuclear cells and the normal serum PCT value is below 0.1 ng/mL in patients
      without signs of systemic inflammation. Serum PCT levels increase postoperatively after
      open-heart surgery and a peak level of 0.5 to 7.0 ng/mL is reported at 24 hours after the
      operation and serum PCT values decrease to normal values within seven days.

      Serum C-reactive protein (CRP) values are often abnormally elevated after open-heart surgery
      as a result of an inflammatory response and it has not been found to be a useful prognostic
      marker due to its prolonged elevation after cardiac surgeries. In the literature, there are
      studies showing that serum PCT levels are consistently higher in patients with postoperative
      complications, however, a cutoff point for serum PCT to determine the risk of possible poor
      outcome has not been well studied. A recent study demonstrated that after CPB, serum PCT
      increased in patients with poor outcome especially in those who developed renal and hepatic
      dysfunction in addition to respiratory and circulatory insufficiency. This study demonstrated
      a cut off value of 2 ng/mL to predict postoperative complications. In another study, a PCT
      level of 2.8 ng/mL was found to be a cut off value to predict 28-day mortality in patients
      after coronary artery bypass grafting (CABG) however, it has been pointed out that there is a
      need for further studies.

      The aim of our study was to investigate a relation between serum values of CRP, PCT, and
      lactate and development of postoperative complications (circulatory failure, pneumonia,
      respiratory insufficiency, sepsis, reoperation, hemorrhage, tamponade, need of inotropic
      support, myocardial infarction, acute kidney injury), in patients undergoing open-heart
      surgery with CPB. A sample size of 72 patients would have a power (1-ß) of 80% to detect a
      difference in serum PCT level of 10% (1 standard deviation) difference between patients with
      postoperative complications (n=36) and without postoperative complications (n=36) using
      2-sided significance and an α=0.05.
    

Intervention name(s): Serum levels of Procalcitonin, C-reactive protein, lactate
Intervention type(s): Diagnostic Test
Intervention description(s): Serum PCT, CRP, and lactate values were collected postoperatively every day starting on postoperative 12 hours, postoperative days 1 through 5.
After the operation, all postoperative complications were recorded during the first seven days period.
The relations between diagnostic tests and postoperative complications are sought by the use of the statistical analysis methods.
Other intervention name(s): Postoperative complications; Type of open-heart surgical operation (coronary artery bypass graft operation, mitral valve, aortic valve or multiple valvular surgeries)
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        The study is performed on a patient population undergoing open-heart surgery with
        cardiopulmonary bypass.
      
Keywords: Open heart surgery; Cardiopulmonary bypass; Procalcitonin; C-reactive protein; Lactate; Outcome; Postoperative Complications