Abstract | OBJECTIVE: Pulmonary endarterectomy (PEA) is an effective and potentially curative treatment for chronic thrombo-embolic pulmonary hypertension (CTEPH). The postoperative course after PEA is accompanied by a number of complications, which contribute to the high rate of early postoperative mortality. Markers allowing the early detection of infectious complication during the postoperative period may be of major clinical importance. The aim of the prospective study was to analyse a predictive value of five inflammatory markers to recognise inflammatory complications accompanying PEA before the first clinical signs of infection. METHODS: RESULTS: Postoperative course was uncomplicated in 59/82 patients (group 1). Fourteen out of 82 patients (group 2) developed an infection in the first 3 days after surgery ( bronchopneumonia, n = 9; bacterial sepsis, n = 5). Nine out of 82 patients (group 3) developed non-infectious complications in the same period. PCT and IL-6 were the only significant independent predictors of infection in days 1-3 after PEA. The area under receiver operating characteristic (ROC) curve calculated for PCT to predict postoperative infection was 0.83 (95% confidence interval (CI): 0.74-0.92) compared with 0.74 (95% CI: 0.68-0.81) for IL-6. With the cut-off 2.3 ng ml(-1), the test characteristics of PCT were as follows: sensitivity, 86%; specificity, 83%; negative predictive value, 92%; and positive predictive value, 84%. CONCLUSIONS: The increase in PCT and IL-6 may allow patients at increased risk of infection after PEA to be identified, allowing earlier institution of antibiotic treatment. These changes that occur before infection can be detected clinically. This finding may make the daily monitoring of PCT post-PEA useful.
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Authors | Pavel Maruna, Jan Kunstyr, Katerina M Plocova, Frantisek Mlejnsky, Jaroslav Hubacek, Andrew A Klein, Jaroslav Lindner |
Journal | European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
(Eur J Cardiothorac Surg)
Vol. 39
Issue 2
Pg. 195-200
(Feb 2011)
ISSN: 1873-734X [Electronic] Germany |
PMID | 20615721
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved. |
Chemical References |
- Biomarkers
- CALCA protein, human
- Inflammation Mediators
- Interleukin-6
- Protein Precursors
- Calcitonin
- C-Reactive Protein
- Calcitonin Gene-Related Peptide
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Topics |
- Aged
- Bacterial Infections
(blood, diagnosis, etiology)
- Biomarkers
(blood)
- C-Reactive Protein
(metabolism)
- Calcitonin
(blood)
- Calcitonin Gene-Related Peptide
- Cardiopulmonary Bypass
- Early Diagnosis
- Endarterectomy
(methods)
- Epidemiologic Methods
- Female
- Humans
- Hypertension, Pulmonary
(etiology, surgery)
- Inflammation Mediators
(blood)
- Interleukin-6
(blood)
- Male
- Middle Aged
- Postoperative Care
(methods)
- Postoperative Complications
(blood, diagnosis)
- Protein Precursors
(blood)
- Pulmonary Artery
(surgery)
- Pulmonary Embolism
(complications, surgery)
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