Procalcitonin (PCT) in cardiac surgery: diagnostic value in systemic inflammatory response syndrome (SIRS), sepsis and after heart transplantation (HTX)

Purpose: Since it is of great importance to distinguish between a systemic inflammatory response syndrome (SIRS) and an infection caused by microbes e specially after heart transplantation (HTX), we examined patients following heart surgery by determining procalcitonin (PCT), because PCT is said to b e secreted only in patients with microbial infections. Methods: Sixty patients undergoing coronary artery bypass grafting (CABG) a nd 14 patients after heart transplantation were included in this prospectiv e study. In the CABG group we had 30 patients without any postoperative com plications (group A). Furthermore we took samples of 30 patients who suffer ed postoperatively from a sepsis (group B, n = 15) or a systemic inflammato ry response syndrome (C, n = 15), In addition we measured the PCT-levels in 65 blood samples of 14 patients after heart transplantation (Group I: reje ction > IIa, II: viral infection (CMV), III: bacterial/fungal infection, IV : controls). Results: In all patients of group A the pre- and intraoperative PCT-values and the measurement at arrival on intensive care unit (ICU) were less than 0.2 ng/ml. On the second postoperative day the PCT-value was 0.33 +/- 0.15 ng/ml in the control group. At the same time it was 19.6 +/- 6.2 ng/ml in s epsis and 0.7 +/- 0.4 ng/ml in systemic inflammatory response syndrome pati ents (P < 0.05). In transplanted patients we could find the following PCT-v alues: Gr.I: 0.18 +/- 0.06 II: 0.30 +/- 0.09 III: 1.63 +/-: 1.16 IV: 0.21 /- 0.09 ng/ml (P < 0.05 comparing group III with I, II and IV). Conclusions: These results show that extracorporeal circulation (ECC) and s ystemic inflammatory response syndrome do not initiate a PCT-secretion. Sep tic conditions cause a significant increase of PCT. In addition, PCT is a r eliable indicator concerning the essential differentiation of bacterial or fungal - not viral - infection and rejection after heart transplantation. ( C) 2000 The international Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rights reserved.