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.