• María Heredia-Rodríguez, Juan Bustamante-Munguira, Mario Lorenzo, Esther Gómez-Sánchez, Álvarez F Javier FJ Department of Pharmacology and Therapeutics, Valladolid University Physicians College, Valladolid, Spain., Inmaculada Fierro, Esther Conejo, and Eduardo Tamayo.
• BioCritic. Group for biomedical Research in Critical Care Medicine, Valladolid, Spain; Department of Anesthesiology and Surgical Critical Care, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
• J. Surg. Res. 2017 May 15; 212: 187-194.

BackgroundSepsis is strongly associated with an increased risk of postoperative mortality, longer length of hospital stay, and elevated health care costs. Early clinical symptoms overlap with those of systemic inflammatory response syndrome, a response that commonly occurs after cardiac surgery with cardiopulmonary bypass. Since a combination of biomarkers has been demonstrated to improve the prediction of postoperative infection, the objective of the present study was to test whether the combination of C-reactive protein (CRP), white blood cells (WBC), and procalcitonin (PCT) is able to predict postoperative infection in a large cohort of cardiac surgery patients.Material And MethodsCase-control study involving 423 patients who underwent cardiac surgery with cardiopulmonary bypass. Patients were retrospectively classified into two groups based on whether they developed severe sepsis or septic shock during the postoperative period. Blood samples for biological measurements (PCT, CRP, and WBC) were drawn on the first day in the intensive care unit, then once daily in the morning until the 10th postoperative day.ResultsCRP median values were similar in both groups. WBC and PCT median values were significantly higher in patients with infection than without during the first 10 postoperative days. With elevation cutoffs ≤3 times (OR: 4.058; 95% CI: 2.206-7.463; P = 0.001) and ≥4 times (OR: 10.274, 95% CI: 3.690-28.604; P < 0.001), the median value for PCT (1.7 ng/mL) and/or WBC (13,000 cells/mm3) on the second postoperative day was significantly associated with the development of infection.ConclusionsThe goal of this study was to use a large cohort of cardiac surgery patients to ensure that the results were representative of this population. The combination of PCT and WBC levels over the first three postoperative days was able to predict postoperative infection within the 30 d following cardiac surgery.Copyright © 2017 Elsevier Inc. All rights reserved.

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