| Abstract: | The diagnostic value of traditional markers of infection and procalcitonin test (PCT) in the early postoperative period was compared in 60 cardiosurgical patients with acquired cardiac diseases and at risk for postoperative infectious complications. The mean age of the patients was 51 +/- 11 years. Preoperatively, all the patients had no signs of infections. The patients were examined before and on days 1, 2, 3, and 6 after surgery. Along with the routine studies (thermometry, general blood analysis), the plasma concentration of PCT was determined by immunoluminometric technique (LUMI-test PCT, Brahms Aktiengesellschaft, Germany). The preoperative level of PCT did not exceed the normal values ( < 0.5 ng/ml). On postoperative days 2 to 17, 14 (23.3%) patients developed infectious complications (Group 2); the other patients were included into a group of comparison (Group 1). Just within the first postoperative days, the levels of PCT were significantly higher in Group 2 patients than in Group 1 (7.58 +/- 2.34 and 3.51 +/- 0.71 ng/ml, respectively; p < 0.05). A difference was found in the count of white blood cells between the groups only from day 3. There were no significant differences in body temperature between the groups. At the second stage of analysis of the data, in accordance with the level of PCT on the first day after surgery and its subsequent changes, all the patients were divided into 4 groups (A-D). The level of PCT on postoperative day was less than 0.5 ng/ml in Group A (n = 6), 0.5-2 ng/ml in Group B (n = 23) and more than 2 ng/ml in groups C (n = 26) and D (n = 5). Subsequently, it was in the normal range in Group A, decreased to the normal values in Groups B and C by day 6 following surgery. The persistence of the high level of PCT was observed in Group D where there were the bulk (60%) of infectious complications. As compared with the traditional clinical and laboratory criteria (fever, leukocytosis), PCT is the earliest and most specific marker of bacterial infection in cardiosurgical patients in the early postoperative period. The level of PCT > 3.5 ng/ml within the first 24 hours after surgery is shown to be a predictor of postoperative infectious complications. |
