Effect of sepsis and cardiac surgery with cardiopulmonary bypass on plasmalevel of nitric oxide metabolites, neopterin, and procalcitonin: correlation with mortality and postoperative complications

Objectives: To examine the hypothesis that nitrite/nitrate, neopterin, and procalcitonin (PCT) levels can be useful predictors of sepsis-associated mo rtality and predictors of the postoperative complications after cardiopulmo nary bypass (CPB). Design. Prospective clinical study. Setting: Intensive care unit of the Medical University Hospital. Patients: 41 patients with sepsis, 42 patients subjected to open heart surg ery with CPB, and 30 healthy volunteers. Measurements and results: Nitrite/nitrate, neopterin, and PCT levels were m easured in septic patients as soon as sepsis was recognized and then on the 2nd, 3rd, and 5th days of treatment. Statistically significant differences between survivors and nonsurvivors were found for neopterin and PCT The ar ea under receiver operating characteristic curve (AUC) for both parameters as predictors of mortality was above 0.8. The nitrite/nitrate level was als o higher in nonsurvivors, but the AUC remained below 0.8, which indicates p oor predictive power. The same parameters were measured in patients undergo ing cardiac surgery before, during and after CPB establishment. The develop ment of post operative complications was correlated with increased postoper ative neopterin and PCT levels. Additionally, neopterin was found as an ear ly marker for the prognosis of postoperative complications, since patients who developed organ dysfunction had had elevated concentration of this para meter even before surgery (AUC 0.83). Measurement of NO metabolite levels w as less specific and less sensitive. Conclusions: Our results confirm the value of PCT and neopterin measurement as diagnostic tools in monitoring the clinical course of patients in inten sive care units.