Abstract: Background
Infections and primary graft dysfunction are devastating complications in the immediate
postoperative period following lung transplantation. Nowadays, reliable diagnostic tools are
not available. Biomarkers could improve early infection diagnosis.
Methods
Multicentre prospective observational study that included all centres authorized to perform
lung transplantation in Spain. Lung infection and/or primary graft dysfunction presentation
during study period (first postoperative week) was determined. Biomarkers were measured
on ICU admission and daily till ICU discharge or for the following 6 consecutive postoperative
days.
Results
We included 233 patients. Median PCT levels were significantly lower in patients with no
infection than in patients with Infection on all follow up days. PCT levels were similar for
PGD grades 1 and 2 and increased significantly in grade 3. CRP levels were similar in all
groups, and no significant differences were observed at any study time point. In the absence
of PGD grade 3, PCT levels above median (0.50 ng/ml on admission or 1.17 ng/ml on day 1)
were significantly associated with more than two- and three-fold increase in the risk of infection
(adjusted Odds Ratio 2.37, 95% confidence interval 1.06 to 5.30 and 3.44, 95% confidence
interval 1.52 to 7.78, respectively). Conclusions
In the absence of severe primary graft dysfunction, procalcitonin can be useful in detecting
infections during the first postoperative week. PGD grade 3 significantly increases PCT levels
and interferes with the capacity of PCT as a marker of infection. PCT was superior to
CRP in the diagnosis of infection during the study period.