Postoperative Complications Clinical Trial
Official title:
Is Procalcitonin a Valuable Marker for the Identification of Postoperative Complications After Open-heart Surgery With Cardiopulmonary Bypass?
The aim of this study was to investigate the impact of serum values of procalcitonin (PCT), C-reactive protein (CRP) and lactate to predict postoperative complications in the early postoperative period after open-heart surgery with cardiopulmonary bypass (CPB).
The cardiopulmonary bypass (CPB) causes an inflammatory response secondary to the activation
of cytokine systems in the whole body. The causes of this inflammation have been discussed
extensively in the literature. As a concise summary the causes can be listed as; 1- the
surgical stress, 2- the recognition of bypass circuit as an artificial surface by the blood
components, 3- ischemia-reperfusion injury, 4- endotoxemia. After open-heart surgery with
CPB, the development of several postoperative complications including myocardial dysfunction,
respiratory failure, renal and neurologic dysfunction, bleeding disorders, altered liver
function, and, multiple organ failure has been demonstrated to be related to the inflammatory
response. Procalcitonin (PCT), is a 116-amino-acid protein that is produced in the liver and
peripheral mononuclear cells and the normal serum PCT value is below 0.1 ng/mL in patients
without signs of systemic inflammation. Serum PCT levels increase postoperatively after
open-heart surgery and a peak level of 0.5 to 7.0 ng/mL is reported at 24 hours after the
operation and serum PCT values decrease to normal values within seven days.
Serum C-reactive protein (CRP) values are often abnormally elevated after open-heart surgery
as a result of an inflammatory response and it has not been found to be a useful prognostic
marker due to its prolonged elevation after cardiac surgeries. In the literature, there are
studies showing that serum PCT levels are consistently higher in patients with postoperative
complications, however, a cutoff point for serum PCT to determine the risk of possible poor
outcome has not been well studied. A recent study demonstrated that after CPB, serum PCT
increased in patients with poor outcome especially in those who developed renal and hepatic
dysfunction in addition to respiratory and circulatory insufficiency. This study demonstrated
a cut off value of 2 ng/mL to predict postoperative complications. In another study, a PCT
level of 2.8 ng/mL was found to be a cut off value to predict 28-day mortality in patients
after coronary artery bypass grafting (CABG) however, it has been pointed out that there is a
need for further studies.
The aim of our study was to investigate a relation between serum values of CRP, PCT, and
lactate and development of postoperative complications (circulatory failure, pneumonia,
respiratory insufficiency, sepsis, reoperation, hemorrhage, tamponade, need of inotropic
support, myocardial infarction, acute kidney injury), in patients undergoing open-heart
surgery with CPB. A sample size of 72 patients would have a power (1-ß) of 80% to detect a
difference in serum PCT level of 10% (1 standard deviation) difference between patients with
postoperative complications (n=36) and without postoperative complications (n=36) using
2-sided significance and an α=0.05.
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