Prognostic value of sCD14-ST (presepsin) in cardiac surgery.

INTRODUCTION: Prediction of complications and mortality after cardiac surgery is an important aspect of timely correction of these conditions. One possibility in this case is the use of biomarkers and some prognostic scores.

AIM OF THE STUDY: To study the prognostic value of presepsin (PSP) as a predictor of postoperative complications development in cardiosurgical patients.

MATERIAL AND METHODS: Patients operated for acquired heart diseases with cardiopulmonary bypass (CPB) were included in the study (n = 51, age: 58 ± 11 years). Besides routine clinical and laboratory data, PSP and procalcitonin (PCT) levels were monitored perioperatively (before surgery, and on the 1(st), 2(nd), 3(rd) and 6(th) day after surgery).

RESULTS: There were no clinical signs of infection before surgery in any of the studied patients. We found supranormal PSP levels in 6 patients (11.8%) before operations (543 [519-602] pg/ml, max 1597 pg/ml; normal value: 365 pg/ml). Infectious complications developed in 19 patients (37%). Statistically significant differences in PSP levels, APACHE II (Acute Physiology and Chronic Health Evaluation II) and SOFA (Sequential Organ Failure Assessment) scores in groups of patients with and without infection were documented from the 1(st) and in PCT from the 2(nd) day after the operation. The cut-off values were 702 pg/ml, 8.5 points, 7.5 points and 3.3 ng/ml, respectively. Hospital mortality was 13.7% (7 patients); all cases of death were in the group of patients with infectious complications. Statistically significant differences in PCT levels, APACHE II and SOFA scores between the groups with favorable and lethal outcomes were observed from the first postoperative day. The same for PSP levels was documented only on the 3(rd) postoperative day. The cut-off values were 7.42 ng/ml, 11 points, 8.5 points and 683 pg/ml, respectively.

CONCLUSION: The use of modern biomarkers alongside integral severity-of-disease scores allows prediction of the risk of infectious complications and mortality in cardiosurgical patients.