Pancreatic Stone Protein Predicts Postoperative Infection in Cardiac Surgery Patients Irrespective of Cardiopulmonary Bypass or Surgical Technique

Abstract

IntroductionWe investigated the role of pancreatic stone protein (PSP) in predicting the occurrence of infection in the postoperative course of cardiac surgery patients. Several biomarkers indicating the presence of inflammation and infection are available in the clinical routine; yet, their utility in the postoperative course of patients following cardiac surgery remains uncertain. Moreover, cardiopulmonary bypass, also referred to as “on-pump surgery”, increases the susceptibility to an exaggerated inflammatory state. However, the impact of such extracorporeal circulation on circulating PSP levels remains poorly understood.MethodsIn a prospective cohort of unselected patients undergoing cardiac surgery, we set out to elucidate the diagnostic accuracy of serum PSP levels as opposed to canonical biomarkers (CRP, WBC) of inflammation to discriminate between the presence of infection and surgical trauma,. In addition, we investigated whether the biomarkers were influenced by the surgical technique employed, i.e. on-pump vs. off-pump and minimally invasive surgery vs. sternotomy. Levels of circulating PSP and routine inflammatory biomarkers (CRP, WBC) were measured in samples taken from 120 patients at baseline as well as at postoperative day 1–3.ResultsUnivariate analysis showed that among the biomarkers investigated, only PSP levels had discriminatory power to differentiate infection from surgical trauma in the postoperative course of the entire cohort of patients following cardiac surgery. With regard to cardiac surgical interventions, there was no significant association between the absence or presence of extracorporeal circulation and PSP levels. However, there was a significant difference in the slope of the rise of postoperative PSP between minimally invasive surgery as opposed to patients subjected to sternotomy.ConclusionIn an unselected population of cardiac surgery patients, post-operative serum PSP levels were significantly associated with the presence of infection in both the on-pump and off-pump setting. Of note, the surgical technique employed (sternotomy vs. minimally invasive approach) had a significant impact on postoperative PSP levels.

Biomarkers of sepsis: time for a reappraisal

“…To diagnose infection in patients with a particular pathology/condition After cardiac surgery Endocan [92], CD64 [93], pancreatic stone protein [94] After major surgery Peptidoglycan [95], elastase [96], leptin [84], calprotectin [75], a proliferation-inducing ligand [97], α-2 macroglobulin [89], lipopolysaccharide-binding protein [15] COPD Pentraxin 3 [98] Cirrhosis Interleukin (IL)-6 [72] Trauma IL-10 [99], NT-proCNP [100], P-selectin [101] Catheter-related infections Citrulline [102] Infants with necrotic enterocolitis IP-10 [103]…”

Biomarkers of sepsis: Time for a Reappraisal

“…Additional le 1 (.pdf) Situation Biomarker To diagnose infection in patients with a particular pathology/condition After cardiac surgery Endocan [111], CD64 [112], pancreatic stone protein [113] After major surgery Peptidoglycan [114], elastase [115], leptin [103], calprotectin [94], a proliferation-inducing ligand [116], α-2 macroglobulin [108], lipopolysaccharide-binding protein [ To diagnose speci c types of infection Gram (-) vs Gram (+) Fibrin degradation products [128], lipopolysaccharidebinding protein [123], CD11b [106]…”

Accuracy of pancreatic stone protein for the diagnosis of infection in hospitalized adults: a systematic review and individual patient level meta-analysis

“…Since its first description as a potential infection biomarker in patients after trauma [ 14 ], pancreatic stone protein has repeatedly been shown to perform better than CRP and at least as well as PCT in identifying patients with infection [ 13 – 15 , 17 , 18 ]. However, in contrast to PCT [ 6 , 26 ], no cut-off threshold value has yet been defined for its eventual clinical use.…”

“…Pancreatic stone protein (PSP) is a pro-inflammatory mediator that binds to polymorphonuclear cells and triggers their activation in vitro (reviewed in [ 12 ]); it is a recently described biomarker of infection whose performance has been thoroughly evaluated in several patient populations and in different clinical settings, including emergency rooms (ERs) [ 13 ] and intensive care units (ICUs) [ 14 – 18 ]. PSP was able not only to diagnose infection [ 14 , 15 , 18 ] but also to characterize its severity [ 16 , 17 ] as well as to predict its outcome [ 16 , 17 , 19 ]. Nevertheless, a clinically useful PSP threshold level has not yet been defined.…”