HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Erwin Domanig Ernst Wolner Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Miholic, J. Articles by Wolner, E. Search for Related Content PubMed PubMed Citation Articles by Miholic, J. Articles by Wolner, E.

Ann Thorac Surg 1986;42:429-433
© 1986 The Society of Thoracic Surgeons

---

Articles

Early Prediction of Deep Sternal Wound Infection after Heart Operations by Alpha-1 Acid Glycoprotein and C-reactive Protein Measurements

From the II. Chirurgische Universitätsklinik and Institut für Statistik und Informatik, University of Vienna, Vienna, Austria

Accepted for publication January 6, 1986.

^* Address reprint requests to Dr. Miholic, II. Chirurgische Universitätsklinik, Allgemeines Krankenhaus, Spitalgasse 23, A-1090 Vienna, Austria

Serum C-reactive protein (CRP) and α₁-acid glycoprotein (AAG) levels were studied in 188 patients undergoing heart operations with cardiopulmonary bypass. Mediastinitis or osteomyelitis of the sternum or both developed in 10 patients on postoperative day 4 to 13 (median, day 9). The mean CRP levels on day 2 were lower in patients with later deep sternal wound infection (9.1 ± 1.5 mg/dl [mean ± standard error]) compared with patients without major infections (14.0 ± 0.8 mg/dl; p = 0.103 [univariate logistic regression]). AAG levels on day 2 reacted in a similar manner, yielding 78.2 ± 5.5 mg/dl and 100.9 ± 2.7 mg/dl, respectively (p = 0.0004). No correlation was found between CRP or AAG and duration of cardiopulmonary bypass, number of blood transfusions, or total protein levels on day 2.

The white blood cell count (WBC) on day 2 was 13.1 ± 1.7 x 10³/µl for patients with infection and 9.7 ± 0.3 for those without infection. Multivariate logistic regression analysis revealed that AAG, WBC, and CRP on day 2 were significant risk factors sufficiently predicting the probability of a deep sternal infection. After adjustment for these three variables, other variables (age, sex, total protein on day 2, diabetes mellitus, type of operation, duration of cardiopulmonary bypass, length of operation, repeat thoracotomy for bleeding, number of blood transfusions on the day of operation, intraaortic balloon pumping, reoperation, emergency operation, and surgeon's professional status) were not of additional significance. The goodness of fit of the statistical model was confirmed by a high correspondence between predicted and observed cases of deep sternal infection. The classification analysis revealed a correct prediction of 90% of patients with infection when 85.5% of the patients without infection were correctly classified. A defect in the trigger mechanism of the acute-phase response or increased degradation by proteases are discussed as possible causes of the lowered AAG and CRP levels. Early identification of patients at risk for postoperative infection may be a new application of acute-phase protein measurements in clinical practice.

This article has been cited by other articles:

				V. G. Fowler Jr, K. S. Kaye, D. L. Simel, C. H. Cabell, D. McClachlan, P. K. Smith, S. Levin, D. J. Sexton, L. B. Reller, G. R. Corey, et al. Staphylococcus aureus Bacteremia After Median Sternotomy: Clinical Utility of Blood Culture Results in the Identification of Postoperative Mediastinitis Circulation, July 8, 2003; 108(1): 73 - 78. [Abstract] [Full Text] [PDF]

				E. J. Fransen, J. G. Maessen, T. W.O. Elenbaas, E. E.H.L. van Aarnhem, and M. P. van Dieijen-Visser Increased preoperative C-reactive protein plasma levels as a risk factor for postoperative infections Ann. Thorac. Surg., January 1, 1999; 67(1): 134 - 138. [Abstract] [Full Text] [PDF]

				Y. Misawa, K. Fuse, and T. Hasegawa Infectious Mediastinitis After Cardiac Operations: Computed Tomographic Findings Ann. Thorac. Surg., March 1, 1998; 65(3): 622 - 624. [Abstract] [Full Text] [PDF]

				K. S. Ulicny Jr, L. F. Hiratzka, R. B. Williams, G. L. Grunkemeier, J. B. Flege Jr, C. B. Wright, G. M. Callard, D. L. Mitts, and E. J. Dunn Sternotomy infection: Poor prediction by acute phase response and delayed hypersensitivity Ann. Thorac. Surg., December 1, 1990; 50(6): 949 - 958. [Abstract] [PDF]