Effect of cardiopulmonary bypass on activated partial thromboplastin time waveform analysis, serum procalcitonin and C-reactive protein concentrations.
Effect of cardiopulmonary bypass on activated partial thromboplastin time waveform analysis, serum procalcitonin and C-reactive protein concentrations.
复制标题
DOI：
10.1186/cc8166
复制
发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Cannesson M
中科院分区：
文献类型：
--
作者：
Delannoy B;Guye ML;Slaiman DH;Lehot JJ;Cannesson M
全身炎症反应综合征（SIRS）是体外循环（CPB）后的常见病症，使得传统的生物测试无法检测术后败血症。双相波形（BPW）分析是一种源自活化部分凝血活酶时间的新生物测试，最近被提议用于脓毒症诊断。本研究的目的是探讨 BPW 检测 CPB 下心脏手术后脓毒症的准确性。我们对美国麻醉医师协会 (ASA) 身体状况 III 级和 IV 级转诊接受体外循环心脏手术的患者进行了一项前瞻性研究。术前和术后第一周每天记录降钙素原 (PCT) 和 BPW。然后将患者分为三组：没有出现 SIRS 的患者、出现非脓毒症 SIRS 的患者和出现脓毒症的患者。其中包括三十二名患者。 16 名患者 (50%) 发生 SIRS，其中 5 名脓毒症患者 (16%) 和 11 名非脓毒症患者 (34%)。与无 SIRS 患者相比，SIRS 患者的 PCT 和 BPW 显着增加（PCT 为 0.9 [0.5-2.2] 与 8.1 [2.0-21.3] ng/l，BPW 为 0.10 [0.09-0.14] 与 0.29 [0.16-0.56] %T/s；两者 P < 0.05）。我们观察到脓毒症组和非脓毒症 SIRS 组之间 PCT 峰值没有差异（8.4 [7.5-32.2] vs. 7.8 [1.9-17.5] ng/l；P = 0.67）。另一方面，我们发现脓毒症组的 BPW 显着高于非脓毒症 SIRS 组（0.57 [0.54-0.78] vs. 0.19 [0.14-0.29] %T/s；P < 0.01）。我们发现 0.465%T/s 的 BPW 阈值能够区分脓毒症和非脓毒症 SIRS 组，敏感性为 100%，特异性为 93%（曲线下面积：0.948 +/- 0.039；P < 0.01）。应用之前发布的 0.25%T/s 阈值，我们发现区分这两组的敏感性为 100%，特异性为 72%。 C反应蛋白（CRP）和PCT均没有显着的预测价值（CRP的曲线下面积为0.659 +/- 0.142；P = 0.26，PCT的曲线下面积为0.704 +/- 0.133；P = 0.15）。 BPW 在 CPB 心脏手术术后脓毒症诊断方面具有潜在的临床应用价值。
Systemic inflammatory response syndrome (SIRS) is a frequent condition after cardiopulmonary bypass (CPB) and makes conventional biological tests fail to detect postoperative sepsis. Biphasic waveform (BPW) analysis is a new biological test derived from activated partial thromboplastin time that has recently been proposed for sepsis diagnosis. The aim of this study was to investigate the accuracy of BPW to detect sepsis after cardiac surgery under CPB. We conducted a prospective study in American Society of Anesthesiologists' (ASA) physical status III and IV patients referred for cardiac surgery under CPB. Procalcitonin (PCT) and BPW were recorded before surgery and every day during the first week following surgery. Patients were then divided into three groups: patients presenting no SIRS, patients presenting with non-septic SIRS and patients presenting with sepsis. Thirty two patients were included. SIRS occurred in 16 patients (50%) including 5 sepsis (16%) and 11 (34%) non-septic SIRS. PCT and BPW were significantly increased in SIRS patients compared to no SIRS patients (0.9 [0.5-2.2] vs. 8.1 [2.0-21.3] ng/l for PCT and 0.10 [0.09-0.14] vs. 0.29 [0.16-0.56] %T/s for BPW; P < 0.05 for both). We observed no difference in peak PCT value between the sepsis group and the non-septic SIRS group (8.4 [7.5-32.2] vs. 7.8 [1.9-17.5] ng/l; P = 0.67). On the other hand, we found that BPW was significantly higher in the sepsis group compared to the non-septic SIRS group (0.57 [0.54-0.78] vs. 0.19 [0.14-0.29] %T/s; P < 0.01). We found that a BPW threshold value of 0.465%T/s was able to discriminate between sepsis and non-septic SIRS groups with a sensitivity of 100% and a specificity of 93% (area under the curve: 0.948 +/- 0.039; P < 0.01). Applying the previously published threshold of 0.25%T/s, we found a sensitivity of 100% and a specificity of 72% to discriminate between these two groups. Neither C-reactive protein (CRP) nor PCT had significant predictive value (area under the curve for CRP was 0.659 +/- 0.142; P = 0.26 and area under the curve for PCT was 0.704 +/- 0.133; P = 0.15). BPW has potential clinical applications for sepsis diagnosis in the postoperative period following cardiac surgery under CPB.
登录
查看更多内容
影响因子：
158.5
作者：
Rivers, E;Nguyen, B;Tomlanovich, M
通讯作者：
Tomlanovich, M
影响因子：
8.8
作者：
Jebali, Mohamed Adel;Hausfater, Pierre;Ferjani, Mustapha
通讯作者：
Ferjani, Mustapha
影响因子：
3.4
作者：
Nashef, SAM;Rogues, F;Salamon, R
通讯作者：
Salamon, R
影响因子：
6.5
作者：
Downey, C;Kazmi, R;Toh, CH
通讯作者：
Toh, CH
影响因子：
120.7
作者：
LEGALL, JR;LEMESHOW, S;SAULNIER, F
通讯作者：
SAULNIER, F