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 especially after heart transplantation (HTX), we examined patients following heart surgery by determining procalcitonin (PCT), because PCT is said to be secreted only in patients with microbial infections. Methods: Sixty patients undergoing coronary artery bypass grafting (CABG) and 14 patients after heart transplantation were included in this prospective study. In the CABG group we had 30 patients without any postoperative complications (group A). Furthermore we took samples of 30 patients who suffered postoperatively from a sepsis (group B, n = 15) or a systemic inflammatory response syndrome (C, n = 15), In addition we measured the PCT-levels in 65 blood samples of 14 patients after heart transplantation (Group I: rejection > 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 sepsis and 0.7 +/- 0.4 ng/ml in systemic inflammatory response syndrome patients (P < 0.05). In transplanted patients we could find the following PCT-values: 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 systemic inflammatory response syndrome do not initiate a PCT-secretion. Septic conditions cause a significant increase of PCT. In addition, PCT is a reliable 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.