Quantitative analysis of procalcitonin after pulmonary endarterectomy in relation to cytokines and C-reactive protein.

BACKGROUND Endarterectomy of the pulmonary artery (PEA) is a potential curative treatment method for selected patients with chronic thromboembolic pulmonary hypertension (CTEPH). The postoperative course after PEA is associated with high rate of early postoperative mortality, which ranges from 5 to 23%. The aim of this prospective clinical study was to assess the time course of procalcitonin (PCT) after uncomplicated PEA in relation to other inflammatory parameters. PATIENTS AND METHODS 32 patients with CTEPH treated with PEA using cardiopulmonary bypass and deep hypothermic circulatory arrest were included into study. PCT, C-reactive protein (CRP), interleukin (IL)-1beta, IL-6, IL-8, and sTNFRI arterial concentrations were measured before/after sternotomy, last DHCA, separation from bypass, and repeatedly to 48 h after sternotomy. RESULTS Mean duration of CPB was 338.2 min.; mean circulatory arrest time 39.9 min. The initial decline of PCT, IL-6, and IL-8 was followed by an increase culminated 6-24 h after sternotomy. PCT peak was detected +24 h (1.97 ng/ml, 1.70-2.54). IL-6 culminated after separation from CPB, IL-8 was highest 12h after sternotomy. PCT levels correlated with IL-6 (r = 0.81), CRP (r = 0.72), and sTNFRI (r = 0.58). CONCLUSION Postoperative PCT culmination was delayed in alignment to pro-inflammatory mediators as IL-6 and IL-8. Positive correlation between PCT and IL-6 corresponded with the role of IL-6 in PCT induction in perioperative phase. Plasma PCT estimation extended to a measurement of CRP and IL-6 may become a useful complementary examination in early postoperative period after PEA.