Perioperative Serum Procalcitonin Concentrations in Patients with Acute Aortic Dissection

Abstract

We investigated the perioperative serum procalcitonin (PCT) concentrations in 5 consecutive patients who underwent surgery for acute aortic dissection (2 men, 3 women; mean age 72 ± 9 years, age range 52–81 years). Surgery used cardiopulmonary bypass with deep hypothermic circulatory arrest. Blood samples were taken prior to surgery, upon arrival in the intensive care unit, and 6, 12, 18, 24, and 48 h after intensive care unit arrival. Prior to surgery, the PCT level was 4.2 ± 3.4 (range 0.8–8.3) ng/ml. The PCT increase was greatest at 24 h (5.8 ± 4.5 ng/ml). Preoperatively, the C-reactive protein concentration was 8.0 ± 8.3 (range 0.9–23.8) mg/dl, and the white blood cell count was 8.5 ± 3.1 × 10³. C-reactive protein continued to increase at 48 h, while the white blood cell count peaked at 24 h. In spite of no symptoms of infectious diseases or septicemia, all patients had a significant preoperative PCT elevation. This finding may have something to do with the specific preoperative condition of acute aortic dissection. However, more clinical investigation is needed to clarify the PCT changes during and after surgery for acute aortic dissection.

Níveis plasmáticos elevados do dímero D e da proteína C reativa hipersensíveis podem indicar desordens aórticas

“…CRP continued to increase at 48 hours after arrival to intensive care unit after surgery [44]. Strong correlations were observed in D-dimer values with circulating CRP values [45].…”

Value of D-dimer and C reactive protein in predicting inhospital death in acute aortic dissection

“…CRP has been recognised to be closely related to the occurrence and development of AD. CRP values were significantly higher in patients with complications of acute AD such as impaired oxygenation, pleural effusion, as well as in patients who died during hospitalisation 4 23 28 – 31. CRP levels above 15 mg/L was an important indicator of impaired oxygenation and poor prognosis 28.…”

Risk Factors for Hypoxemia After Surgery for Acute Type A Aortic Dissection

“…Systemic inflammatory reactions after the onset of acute aortic dissection have been described. 10,11 We previously reported that the serum concentration of procalcitonin, a proposed indicator of systemic inflammation, was increased at the time of admission in patients with acute aortic dissection. 10 Hasegawa et al 11 also reported that oxygenation was impaired from the onset of dissection of day 3 in patients treated conservatively for acute aortic dissection, and that interleukin-8 levels were elevated in patients with impaired oxygenation.…”

“…10,11 We previously reported that the serum concentration of procalcitonin, a proposed indicator of systemic inflammation, was increased at the time of admission in patients with acute aortic dissection. 10 Hasegawa et al 11 also reported that oxygenation was impaired from the onset of dissection of day 3 in patients treated conservatively for acute aortic dissection, and that interleukin-8 levels were elevated in patients with impaired oxygenation. Another report suggested that cytokines can amplify the inflammatory cascade, resulting in increased endothelial and epithelial permeability, increased pulmonary vascular pressures, and impaired alveolar surfactant function, 12 which can lead to a decrease in the preoperative PaO 2 /FiO 2 ratio.…”