Assessment of the accuracy of procalcitonin to diagnose postoperative infection after cardiac surgery
Assessment of the accuracy of procalcitonin to diagnose postoperative infection after cardiac surgery
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DOI：
10.1097/01.anes.0000271871.07395.ad
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发表时间：
2007-08-01
期刊：
影响因子：
8.8
通讯作者：
Ferjani, Mustapha
中科院分区：
文献类型：
--
作者：
Jebali, Mohamed Adel;Hausfater, Pierre;Ferjani, Mustapha
背景：心脏搭桥术诱导非特异性炎症反应。降钙素原被认为是感染的特异性生物标志物。作者研究了降钙素原诊断心脏手术后感染的准确性，并与C-反应蛋白、白色血细胞计数、白细胞介素6和白细胞介素8进行了比较。方法：作者前瞻性地纳入了100例择期心脏手术的心肺转流患者。在术前和术后7天内每天采集血样，并测量降钙素原、C反应蛋白、白色血细胞计数和白细胞介素6和8。由设盲的专家小组进行感染诊断。结果：16例患者被诊断为感染。降钙素原在感染患者中显著升高，在术后第三天达到峰值。只有降钙素原（0.88 [0.71-0-951]）和C-反应蛋白（0.72 [0-58-0-821]）的受试者工作曲线下面积与无区分曲线有显著差异，降钙素原的受试者工作曲线下面积与C-反应蛋白、白色血细胞计数以及白细胞介素6和8的受试者工作曲线下面积有显著差异。第二天后降钙素原值大于1.5 ng/ml诊断为术后感染，敏感性为0.93 [0.70-0.99]，特异性为0.80 [0.70-0.87]。降钙素原在死亡患者中显著升高（27.5 [1.65-40-51] ng/ml vs.1.2 [0.7-1-5] ng/ml; P < 0.001）。结论：降钙素原是心脏手术后细菌感染的一个有价值的标志物。
Background: Cardiopulmonary bypass induces a nonspecific inflammatory response. Procalcitonin has been advocated as a specific biomarker for infection. The authors studied the accuracy of procalcitonin to diagnose postoperative infection after cardiac surgery and compared it with those of C-reactive protein, white blood cell count, and interleukins 6 and 8.Methods: The authors prospectively included 100 patients scheduled to undergo elective cardiac procedures with cardio-pulmonary bypass. Blood samples were taken before surgery and each day over the 7-day postoperative period, and measurement of procalcitonin, C-reactive protein, white blood cell count, and interleukins 6 and 8 were performed. Diagnosis of infection was performed by a blinded expert panel. Data are expressed as value [95% confidence interval].Results: Infection was diagnosed in 16 patients. Procalcitonin was significantly higher in infected patients, with a peak reached on the third postoperative day. Only the areas under the receiver operating curve of procalcitonin (0.88 [0.71-0-951) and C-reactive protein (0.72 [0-58-0-821) were significantly different from the no-discrimination curve, and that of procalcitonin was significantly different from those of C-reactive protein, white blood cell count, and interleukins 6 and 8. A procalcitonin value greater than 1.5 ng/ml beyond the second day diagnosed postoperative infection with a sensitivity of 0.93 [0.70-0.99] and a specificity of 0.80 [0.70-0.87]. Procalcitonin was significantly higher in patients who died (27.5 [1.65-40-51 vs. 1.2 [0.7-1-5] ng/ml; P < 0.001).Conclusion: Procalcitonin is a valuable marker of bacterial infections after cardiac surgery.