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Early Kinetics of procalcitonin in Predicting Surgical Outcomes in Type A Aortic Dissection Patients

Chinese Medical Journal 2017年第10期130卷 1175-1181页

作者： Hua Liu Zhe Luo Lan Liu Xiao-Mei Yang Ya-Min Zhuang Ying Zhang Guo-Wei Tu Guo-Guang Ma Guang-Wei Hao Jian-Feng LUO Ji-Li Zheng Chun-Sheng Wang Department of Intensive Care Medicine Zhongshan Hospital Fudan University Shanghai 200032 China Department of Biostatistics School of Public Health Fudan University Shanghai 200032 China Department of Cardiac Surgery Zhongshan Hospital Fudan University Shanghai 200032 China

Background： In cardiac surgery, elevation of procalcitonin （PCT） could be observed postoperatively in the absence of any evidence of infection and also seems to be a prognostic marker. PCT levels measured in patients undergoing Type A aortic dissection （TAAD） were used to determine prognostic values for complications and surgical outcomes. Methods： Measurements of PCT, C-reactive protein （CRP）, and leukocyte count were observed in TAAD surgery patients （n = 251 ; average age： 49.02 ± 12.83 years; 78.5% male） at presurgery （TO） and 24 h （T1）, 48 h （T2）, and 7 days （T3） postsurgery. PCT clearance （PCTc） oll days 2 and 7 was calculated：（PCTd - PCTd,±,, d,,v）/PCTdx 100%. Endotracheal intubation duration, length of stay （LOS） in the Intensive Care Unit （1CU）/hospital, and complications were recorded± Results： PCT peaked 24 h postsurgery （median 2.73 ng/ml） before decreasing, Correlation existed between PCT levels at T1 and duration of cardiopulmonary bypass （P = 0.001, r = 0.278）. Serum PCT concentrations were significantly higher in nonsurvivor and multiple organ dysfunction syndrome groups on all postoperative days. PCT levels at T1 correlated with length of time of ventilation support and ICU/hospital LOS. Comparing PCT values of survivors versus nonsurvivors, a PCT cutoff level of 5.86 ng/ml at T2 had high sensitivity （70.6%） and specificity （74.3%） in predicting in-hospital death. PCTc-day 2 and 7 were significantly higher in survivor compared with nonsurvivor patients （38% vs. 8%, P = 0.012, 83% vs. -39%, P 〈 0.001）. A PCTc-day 7 cutoff point of 48.7% predicted survival with high sensitivity （77.8%） and specificity （81.8%）. Conclusions： PCT level and PCTc after TAAD surgery might serve as early prognostic markers to predict postoperative outcome. PCT measurement may help identify high-risk patients.

关键词： Perioperative Period procalcitonin: sensitivity Specificity Type A Aortic Dissection

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