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Nicolotti D, Grossi S, Palermo V, Pontone F, Maglietta G, Diodati F, Puntoni M, Rossi S, Caminiti C. Procalcitonin for the diagnosis of postoperative bacterial infection after adult cardiac surgery: a systematic review and meta-analysis. Crit Care 2024; 28:44. [PMID: 38326921 PMCID: PMC10848477 DOI: 10.1186/s13054-024-04824-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND AND AIMS Patients undergoing cardiac surgery are subject to infectious complications that adversely affect outcomes. Rapid identification is essential for adequate treatment. Procalcitonin (PCT) is a noninvasive blood test that could serve this purpose, however its validity in the cardiac surgery population is still debated. We therefore performed a systematic review and meta-analysis to estimate the accuracy of PCT for the diagnosis of postoperative bacterial infection after cardiac surgery. METHODS We included studies on adult cardiac surgery patients, providing estimates of test accuracy. Search was performed on PubMed, EmBase and WebOfScience on April 12th, 2023 and rerun on September 15th, 2023, limited to the last 10 years. Study quality was assessed with the QUADAS-2 tool. The pooled measures of performance and diagnostic accuracy, and corresponding 95% Confidence Intervals (CI), were calculated using a bivariate regression model. Due to the variation in reported thresholds, we used a multiple-thresholds within a study random effects model for meta-analysis (diagmeta R-package). RESULTS Eleven studies were included in the systematic review, and 10 (2984 patients) in the meta-analysis. All studies were single-center with observational design, five of which with retrospective data collection. Quality assessment highlighted various issues, mainly concerning lack of prespecified thresholds for the index test in all studies. Results of bivariate model analysis using multiple thresholds within a study identified the optimal threshold at 3 ng/mL, with a mean sensitivity of 0.67 (0.47-0.82), mean specificity of 0.73 (95% CI 0.65-0.79), and AUC of 0.75 (IC95% 0.29-0.95). Given its importance for practice, we also evaluated PCT's predictive capability. We found that positive predictive value is at most close to 50%, also with a high prevalence (30%), and the negative predictive value was always > 90% when prevalence was < 20%. CONCLUSIONS These results suggest that PCT may be used to help rule out infection after cardiac surgery. The optimal threshold of 3 ng/mL identified in this work should be confirmed with large, well-designed randomized trials that evaluate the test's impact on health outcomes and on the use of antibiotic therapy. PROSPERO Registration number CRD42023415773. Registered 22 April 2023.
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Affiliation(s)
- Davide Nicolotti
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Parma, Parma, Italy
| | - Silvia Grossi
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Parma, Parma, Italy
| | - Valeria Palermo
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Parma, Parma, Italy
| | - Federico Pontone
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Parma, Parma, Italy
| | - Giuseppe Maglietta
- Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy.
| | - Francesca Diodati
- Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | - Matteo Puntoni
- Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | - Sandra Rossi
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Parma, Parma, Italy
| | - Caterina Caminiti
- Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
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Lehnert T, Leonhardt I, Timme S, Thomas-Rüddel D, Bloos F, Sponholz C, Kurzai O, Figge MT, Hünniger K. Ex vivo immune profiling in patient blood enables quantification of innate immune effector functions. Sci Rep 2021; 11:12039. [PMID: 34103589 PMCID: PMC8187451 DOI: 10.1038/s41598-021-91362-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/25/2021] [Indexed: 02/05/2023] Open
Abstract
The assessment of a patient's immune function is critical in many clinical situations. In complex clinical immune dysfunction like sepsis, which results from a loss of immune homeostasis due to microbial infection, a plethora of pro- and anti-inflammatory stimuli may occur consecutively or simultaneously. Thus, any immunomodulatory therapy would require in-depth knowledge of an individual patient's immune status at a given time. Whereas lab-based immune profiling often relies solely on quantification of cell numbers, we used an ex vivo whole-blood infection model in combination with biomathematical modeling to quantify functional parameters of innate immune cells in blood from patients undergoing cardiac surgery. These patients experience a well-characterized inflammatory insult, which results in mitigation of the pathogen-specific response patterns towards Staphylococcus aureus and Candida albicans that are characteristic of healthy people and our patients at baseline. This not only interferes with the elimination of these pathogens from blood, but also selectively augments the escape of C. albicans from phagocytosis. In summary, our model could serve as a valuable functional immune assay for recording and evaluating innate responses to infection.
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Affiliation(s)
- Teresa Lehnert
- grid.418398.f0000 0001 0143 807XResearch Group Applied Systems Biology, Leibniz Institute for Natural Product Research and Infection Biology ‐ Hans Knöll Institute, Jena, Germany ,grid.275559.90000 0000 8517 6224Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Ines Leonhardt
- grid.275559.90000 0000 8517 6224Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany ,grid.418398.f0000 0001 0143 807XResearch Group Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology ‐ Hans Knöll Institute, Jena, Germany
| | - Sandra Timme
- grid.418398.f0000 0001 0143 807XResearch Group Applied Systems Biology, Leibniz Institute for Natural Product Research and Infection Biology ‐ Hans Knöll Institute, Jena, Germany
| | - Daniel Thomas-Rüddel
- grid.275559.90000 0000 8517 6224Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany ,grid.275559.90000 0000 8517 6224Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Frank Bloos
- grid.275559.90000 0000 8517 6224Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany ,grid.275559.90000 0000 8517 6224Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Christoph Sponholz
- grid.275559.90000 0000 8517 6224Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Oliver Kurzai
- grid.275559.90000 0000 8517 6224Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany ,grid.418398.f0000 0001 0143 807XResearch Group Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology ‐ Hans Knöll Institute, Jena, Germany ,grid.8379.50000 0001 1958 8658Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Marc Thilo Figge
- grid.418398.f0000 0001 0143 807XResearch Group Applied Systems Biology, Leibniz Institute for Natural Product Research and Infection Biology ‐ Hans Knöll Institute, Jena, Germany ,grid.275559.90000 0000 8517 6224Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany ,grid.9613.d0000 0001 1939 2794Institute of Microbiology, Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany
| | - Kerstin Hünniger
- grid.418398.f0000 0001 0143 807XResearch Group Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology ‐ Hans Knöll Institute, Jena, Germany ,grid.8379.50000 0001 1958 8658Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
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Albacker TB, Fouda M, Bakir BM, Eldemerdash A. The effect of using the minimized cardio-pulmonary bypass Systems for Coronary Artery Bypass Grafting in diabetic patients. J Cardiothorac Surg 2021; 16:162. [PMID: 34099011 PMCID: PMC8182931 DOI: 10.1186/s13019-021-01551-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 05/26/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Multiple studies have shown a decrease in the inflammatory response with minimized bypass circuits leading to less complications and mortality rate. On the other hand, some other studies showed that there is no difference in post-operative outcomes. So, the aim of this study is to investigate the clinical benefits of using the Minimized cardiopulmonary Bypass system in Coronary Artery Bypass Grafting and its effect on postoperative morbidity and mortality in diabetic patients as one of the high-risk groups that may benefit from these systems. Methods This is a retrospective study that included 114 diabetic patients who underwent Coronary artery bypass grafting (67 patients with conventional cardiopulmonary bypass system and 47 with Minimized cardiopulmonary bypass system). The patients’ demographics, intra-operative characteristics and postoperative complications were compared between the two groups. Results Coronary artery bypass grafting was done on a beating heart less commonly in the conventional cardiopulmonary bypass group (44.78% vs. 63.83%, p = 0.045). There was no difference between the two groups in blood loss or transfusion requirements. Four patients in the conventional cardiopulmonary bypass group suffered perioperative myocardial infarction while no one had perioperative myocardial infarction in the Minimized cardiopulmonary bypass group. On the other hand, less patients in the conventional group had postoperative Atrial Fibrillation (4.55% vs. 27.5%, p = 0.001). The requirements for Adrenaline and Nor-Adrenaline infusions were more common the conventional group than the Minimized group. Conclusion The use of conventional cardiopulmonary bypass for Coronary Artery Bypass Grafting in diabetic patients was associated with higher use of postoperative vasogenic and inotropic support. However, that did not translate into higher complications rate or mortality.
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Affiliation(s)
- Turki B Albacker
- Cardiac Sciences Department, College of Medicine, King Fahad Cardiac Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Mohammed Fouda
- Cardiac Sciences Department, College of Medicine, King Fahad Cardiac Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Bakir M Bakir
- Cardiac Sciences Department, College of Medicine, King Fahad Cardiac Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Eldemerdash
- Cardiac Sciences Department, College of Medicine, King Fahad Cardiac Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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