TM and t-PAIC may be possible biomarkers to predict postoperative infection after cardiac surgery with cardiopulmonary bypass.

BACKGROUND

While cardiac surgery and cardiopulmonary bypass (CPB) are on rise, postoperative infections have become an increasingly prominent problem. We designed this study to compare the four coagulation indicators involving endothelial injury and identify important predictors of postoperative infection after cardiac surgery with CPB.

METHODS

This is a single-center, prospective, observational study of postoperative cardiac surgery patients admitted to the department of critical care medicine, Peking Union Medical College Hospital from July 15, 2024 to August 26, 2024. Patients postoperatively after cardiac surgery with CPB during the study period were included. A total of 40 patients were included finally, comprising 34 in the Control group and 6 in the Infection group. Data on coagulation and inflammatory markers of above patients were collected. Above markers included thrombomodulin (TM), thrombin-antithrombin complex (TAT), plasmin-α2-plasmininhibitor complex (PIC), and tissue plasminogen activator-inhibitor complex (t-PAIC), tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8, and IL-10 concentration.

RESULTS

Postoperative infection after cardiac surgery with CPB was 15% (6 / 40) in this study. Blood TM and t-PAIC levels in the Infection group increased significantly compared to the Control group (P < 0.05). There was no statistically significant difference in TAT, PIC, TNF-α, IL-6, IL-8, and IL-10 levels the Control group and the Infection group. For postoperative infection after cardiac surgery with CPB, the AUROC of blood TM levels was 0.806 ([95% CI], [0.643, 0.970]) and the AUROC of blood t-PAIC levels was 0.730 ([95% CI], [0.473, 0.988]).

CONCLUSIONS

TM and t-PAIC were higher in patients who developed postoperative infection after cardiac surgery with CPB and may be possible biomarkers, but larger studies are needed to confirm their value.

TRIAL REGISTRATION: registry: Chinese Clinical Trial Registry, trial registration number: ChiCTR2600118480 ( https://www.chictr.org.cn ), data of registration: 2026/2/6, retrospectively registered.