Matthias Klingele1, Hagen Bomberg2, Aaron Poppleton1, Peter Minko3, Thimo Speer1, Hans-Joachim Schäfers4, Heinrich V Groesdonk5. 1. Department of Medicine, Division of Nephrology and Hypertension, Saarland University Medical Center, Homburg/Saar, Germany. 2. Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Homburg/Saar, Germany. 3. Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany. 4. Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany. 5. Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Homburg/Saar, Germany. Electronic address: heinrich.groesdonk@uks.eu.
Abstract
BACKGROUND: Nonocclusive mesenteric ischemia (NOMI) can occur after cardiac surgery, commonly in conjunction with use of cardiopulmonary bypass. Some evidence suggests that serum procalcitonin (PCT) levels are increased in patients with mesenteric ischemia; however, an association between PCT and NOMI has not yet been studied. The current study investigates whether elevated serum PCT levels are found in patients exhibiting NOMI. METHODS: In an observational cohort study of 865 patients undergoing elective cardiac surgery, 78 experienced NOMI. Preoperative and postoperative PCT levels were determined by means of enzyme-linked immunosorbent assay. Odds ratios and 95% confidence intervals were calculated by logistic regression analyses to predict accuracy of PCT in identifying patients with NOMI. Additional models were calculated, adjusting for potential confounders. RESULTS: Patients with NOMI had higher postoperative PCT levels than control patients (20.8 ± 3.2 ng/mL versus 2.3 ± 1.1 ng/mL; p < 0.001). Likelihood of experiencing NOMI increased with each nanogram per milliliter rise in postoperative PCT level (odds ratio, 2.61; 95% confidence interval, 2.05 to 3.32). Receiver operating characteristic analyses showed elevated serum PCT levels to accurately predict occurrence of NOMI (optimal cutoff value, 6.6 ng/mL; area under the curve, 0.94; sensitivity, 71%; specificity, 94%). CONCLUSIONS: Postoperative measurement of PCT seems useful to improve the clinical and noninvasive identification of patients with NOMI after cardiac surgery.
BACKGROUND: Nonocclusive mesenteric ischemia (NOMI) can occur after cardiac surgery, commonly in conjunction with use of cardiopulmonary bypass. Some evidence suggests that serum procalcitonin (PCT) levels are increased in patients with mesenteric ischemia; however, an association between PCT and NOMI has not yet been studied. The current study investigates whether elevated serum PCT levels are found in patients exhibiting NOMI. METHODS: In an observational cohort study of 865 patients undergoing elective cardiac surgery, 78 experienced NOMI. Preoperative and postoperative PCT levels were determined by means of enzyme-linked immunosorbent assay. Odds ratios and 95% confidence intervals were calculated by logistic regression analyses to predict accuracy of PCT in identifying patients with NOMI. Additional models were calculated, adjusting for potential confounders. RESULTS:Patients with NOMI had higher postoperative PCT levels than control patients (20.8 ± 3.2 ng/mL versus 2.3 ± 1.1 ng/mL; p < 0.001). Likelihood of experiencing NOMI increased with each nanogram per milliliter rise in postoperative PCT level (odds ratio, 2.61; 95% confidence interval, 2.05 to 3.32). Receiver operating characteristic analyses showed elevated serum PCT levels to accurately predict occurrence of NOMI (optimal cutoff value, 6.6 ng/mL; area under the curve, 0.94; sensitivity, 71%; specificity, 94%). CONCLUSIONS: Postoperative measurement of PCT seems useful to improve the clinical and noninvasive identification of patients with NOMI after cardiac surgery.