Clinical and laboratory features of patients with postoperative pneumonia after cardiac surgery
DOI:
https://doi.org/10.18203/2320-6012.ijrms20260938Keywords:
Procalcitonin, Cardiothoracic surgery, Echocardiography, Postoperative pneumonia, Anaemia, Antibiotic therapyAbstract
Background: Following cardiothoracic surgery, postoperative pneumonia (POP) represents a major clinical sequela. This study compared clinical and diagnostic features among the patients who developed POP and those with an uncomplicated recovery.
Methods: In a retrospective single-centre analysis, 95 patients who had open-heart surgery were divided into group 1 (POP, n=53) and group 2 (no major complications, n=42). We analysed demographics, comorbidities, laboratory results, and echocardiographic data.
Results: While baseline characteristics were similar, group 1 had a significantly higher prevalence of anaemia (98% versus 70%, p<0.001) and postoperative pneumothorax (17% versus 2%, p=0.020). Laboratory findings showed markedly elevated inflammatory biomarkers, including C-reactive protein and procalcitonin (p<0.001), in group 1. Echocardiography revealed a lower left ventricular ejection fraction (57.3% versus 62.8%, p=0.037) and more frequent pericardial effusion (p=0.026) in these patients.
Conclusions: POP is associated with a distinct profile featuring significant anaemia, elevated specific infection biomarkers, slightly impaired left ventricular function, and increased pulmonary complications. The study thus underscores potential focuses for improving both patient assessment before surgery and diagnosis after the procedure.
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References
Ferguson TB Jr, Hammill BG, Peterson ED, DeLong ER, Grover FL; STS National Database Committee. A decade of change--risk profiles and outcomes for isolated coronary artery bypass grafting procedures, 1990-1999: a report from the STS National Database Committee and the Duke Clinical Research Institute. Society of Thoracic Surgeons. Ann Thorac Surg. 2002;73(2):480-9. DOI: https://doi.org/10.1016/S0003-4975(01)03339-2
Wang D, Huang X, Wang H, Le S, Yang H, Wang F, et al. Risk factors for postoperative pneumonia after cardiac surgery: a prediction model. J Thorac Dis. 2021;13(4):2351-62. DOI: https://doi.org/10.21037/jtd-20-3586
Bouza E, Pérez A, Muñoz P, Jesús Pérez M, Rincón C, Sánchez C, et al; Cardiovascular Infection Study Group. Ventilator-associated pneumonia after heart surgery: a prospective analysis and the value of surveillance. Crit Care Med. 2003;31(7):1964-70. DOI: https://doi.org/10.1097/01.ccm.0000084807.15352.93
Hortal J, Giannella M, Pérez MJ, Barrio JM, Desco M, Bouza E, et al. Incidence and risk factors for ventilator-associated pneumonia after major heart surgery. Intensive Care Med. 2009;35(9):1518-25. DOI: https://doi.org/10.1007/s00134-009-1523-3
Kollef MH, Hamilton CW, Ernst FR. Economic impact of ventilator-associated pneumonia in a large matched cohort. Infect Control Hosp Epidemiol. 2012;33(3):250-6. DOI: https://doi.org/10.1086/664049
Lugg ST, Agostini PJ, Tikka T, Kerr A, Adams K, Bishay E, et al. Long-term impact of developing a postoperative pulmonary complication after lung surgery. Thorax. 2016;71(2):171-6. DOI: https://doi.org/10.1136/thoraxjnl-2015-207697
Hein OV, Birnbaum J, Wernecke K, England M, Konertz W, Spies C. Prolonged intensive care unit stay in cardiac surgery: risk factors and long-term-survival. Ann Thorac Surg. 2006;81(3):880-5. DOI: https://doi.org/10.1016/j.athoracsur.2005.09.077
Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg. 2002;21(2):232-44. DOI: https://doi.org/10.1016/S1010-7940(01)01099-5
Warren OJ, Smith AJ, Alexiou C, Rogers PL, Jawad N, Vincent C, et al. The inflammatory response to cardiopulmonary bypass: part 1--mechanisms of pathogenesis. J Cardiothorac Vasc Anesth. 2009;23(2):223-31. DOI: https://doi.org/10.1053/j.jvca.2008.08.007
American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388-416. DOI: https://doi.org/10.1164/rccm.200405-644ST
Muscedere J, Dodek P, Keenan S, Fowler R, Cook D, Heyland D; VAP Guidelines Committee and the Canadian Critical Care Trials Group. Comprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: prevention. J Crit Care. 2008;23(1):126-37. DOI: https://doi.org/10.1016/j.jcrc.2007.11.014
Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63(5):e61-e111. DOI: https://doi.org/10.1093/cid/ciw353
Schuetz P, Wirz Y, Sager R, Christ-Crain M, Stolz D, Tamm M, et al. Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis. Lancet Infect Dis. 2018;18(1):95-107. DOI: https://doi.org/10.1016/S1473-3099(17)30592-3
Müller B, Becker KL, Schächinger H, Rickenbacher PR, Huber PR, Zimmerli W, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med. 2000;28(4):977-83. DOI: https://doi.org/10.1097/00003246-200004000-00011
Wacker C, Prkno A, Brunkhorst FM, Schlattmann P. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(5):426-35. DOI: https://doi.org/10.1016/S1473-3099(12)70323-7
Leroux P, De Ruffi S, Ramont L, Gornet M, Giordano Orsini G, Losset X, et al. Clinical Outcome Predictive Value of Procalcitonin in Patients Suspected with Infection in the Emergency Department. Emerg Med Int. 2021;2021:2344212. DOI: https://doi.org/10.1155/2021/2344212
TItova EA, Eyrikh AR, Titova ZA. The role of presepsin in the diagnosis and assessment of severity of sepsis and severe pneumonia. Ter Arkh. 2018;90(11):44-7. DOI: https://doi.org/10.26442/terarkh201890114-47
Karkouti K, Wijeysundera DN, Beattie WS; Reducing Bleeding in Cardiac Surgery (RBC) Investigators. Risk associated with preoperative anemia in cardiac surgery: a multicenter cohort study. Circulation. 2008;117(4):478-84. DOI: https://doi.org/10.1161/CIRCULATIONAHA.107.718353
Thomsen RW, Kasatpibal N, Riis A, Nørgaard M, Sørensen HT. The impact of pre-existing heart failure on pneumonia prognosis: population-based cohort study. J Gen Intern Med. 2008;23(9):1407-13. DOI: https://doi.org/10.1007/s11606-008-0672-3
Sanfilippo F, Corredor C, Fletcher N, Landesberg G, Benedetto U, Foex P, et al. Diastolic dysfunction and mortality in septic patients: a systematic review and meta-analysis. Intensive Care Med. 2015;41(6):1004-13. DOI: https://doi.org/10.1007/s00134-015-3748-7
Fowler AJ, Ahmad T, Phull MK, Allard S, Gillies MA, Pearse RM. Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg. 2015;102(11):1314-24. DOI: https://doi.org/10.1002/bjs.9861
Muñoz M, Acheson AG, Auerbach M, Besser M, Habler O, Kehlet H, et al. International consensus statement on the peri-operative management of anaemia and iron deficiency. Anaesthesia. 2017;72(2):233-47. DOI: https://doi.org/10.1111/anae.13773
Serpa Neto A, Cardoso SO, Manetta JA, Pereira VG, Espósito DC, Pasqualucci Mde O, et al. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA. 2012;308(16):1651-9. DOI: https://doi.org/10.1001/jama.2012.13730
Torres A, Niederman MS, Chastre J, Ewig S, Fernandez-Vandellos P, Hanberger H, et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT). Eur Respir J. 2017;50(3):1700582. DOI: https://doi.org/10.1183/13993003.00582-2017
Moniz P, Coelho L, Póvoa P. Antimicrobial Stewardship in the Intensive Care Unit: The Role of Biomarkers, Pharmacokinetics, and Pharmacodynamics. Adv Ther. 2021;38(1):164-79. DOI: https://doi.org/10.1007/s12325-020-01558-w
Meier MA, Branche A, Neeser OL, Wirz Y, Haubitz S, Bouadma L, et al. Procalcitonin-guided Antibiotic Treatment in Patients With Positive Blood Cultures: A Patient-level Meta-analysis of Randomized Trials. Clin Infect Dis. 2019;69(3):388-96. DOI: https://doi.org/10.1093/cid/ciy917
Wirz Y, Meier MA, Bouadma L, Luyt CE, Wolff M, Chastre J, et al. Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials. Crit Care. 2018;22(1):191. DOI: https://doi.org/10.1186/s13054-018-2125-7
Rudiger A, Singer M. Mechanisms of sepsis-induced cardiac dysfunction. Crit Care Med. 2007;35(6):1599-608. DOI: https://doi.org/10.1097/01.CCM.0000266683.64081.02
Imazio M, Brucato A, Ferrazzi P, Spodick DH, Adler Y. Postpericardiotomy syndrome: a proposal for diagnostic criteria. J Cardiovasc Med (Hagerstown). 2013;14(5):351-3. DOI: https://doi.org/10.2459/JCM.0b013e328353807d
Gilbertson DT, Wetmore JB. Infections Requiring Hospitalization in Patients on Hemodialysis. Clin J Am Soc Nephrol. 2015;10(12):2101-3. DOI: https://doi.org/10.2215/CJN.10891015
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