Article

Procalcitonin as a marker of bacterial infection in children undergoing cardiac surgery with cardiopulmonary bypass.

Pediatric Cardiology Unit, Nantes University Hospital, Nantes, France.
Cardiology in the Young (Impact Factor: 0.95). 03/2011; 21(4):392-9. DOI: 10.1017/S104795111100014X
Source: PubMed

ABSTRACT Owing to systemic inflammatory response syndrome, the diagnosis of post-operative infection after cardiopulmonary bypass is difficult to assess in children with the usual clinical and biological tools. Procalcitonin could be informative in this context.
Retrospective study in a paediatric intensive care unit. Blood samples were collected as soon as infection was clinically suspected and a second assay was performed 24 hours later. Using referenced criteria, children were retrospectively classified into two groups: infected and non-infected.
Out of the 95 children included, 14 were infected. Before the third post-operative day, procalcitonin median concentration was significantly higher in the infected group than in the non-infected group - 20.24 nanograms per millilitre with a 25th and 75th interquartile of 15.52-35.71 versus 0.72 nanograms per millilitre with a 25th and 75th interquartile of 0.28 to 5.44 (p = 0.008). The area under the receiver operating characteristic curve was 0.89 with 95% confidence intervals from 0.80 to 0.97. The best cut-off value to differentiate infected children from healthy children was 13 nanograms per millilitre with 100% sensitivity - 95% confidence intervals from 51 to 100 - and 85% specificity - 95% confidence intervals from 72 to 91. After the third post-operative day, procalcitonin was not significantly higher in infected children - 2 nanograms per millilitre with a 25th and 75th interquartile of 0.18 to 12.42 versus 0.37 nanograms per millilitre with a 25th and 75th interquartile of 0.24 to 1.32 (p = 0.26). The area under the receiver operating characteristic curve was 0.62 with 95% confidence intervals from 0.47 to 0.77. A procalcitonin value of 0.38 nanograms per millilitre provided a sensitivity of 70% with 95% confidence intervals from 39 to 89 for a specificity of 52% with 95% confidence intervals from 34 to 68. After the third post-operative day, a second assay at a 24-hour interval can improve the sensitivity of the test.
Procalcitonin seems to be a discriminating marker of bacterial infection during the post-operative days following cardiopulmonary bypass in children.

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    ABSTRACT: Background:The utility of procalcitonin and C-reactive protein (CRP) as infectious biomarkers following infant cardiothoracic surgery is not well defined.Methods:We designed a prospective cohort study to evaluate procalcitonin and CRP after infant cardiothoracic surgery. Procalcitonin and CRP were drawn pre-operatively and 24/72 hours post-operation or daily in delayed sternal closure patients. Presence of infection within 10 days of surgery, vasoactive-inotropic scores at 24 and 72 hours, and length of intubation, intensive care unit stay, and hospital stay were documented.Results:Procalcitonin and CRP were elevated at 24 hours. Procalcitonin then decreased while CRP increased in patients undergoing delayed sternal closure or cardiopulmonary bypass. In the delayed sternal closure group, procalcitonin was significantly higher on post-operative days 2-5 in patients who ultimately developed infection. Higher procalcitonin was independently associated with increased vasoactive-inotropic score at 72 hours. CRP did not correlate with infection or post-operative support.Conclusions:Procalcitonin rises after cardiothoracic surgery in infants but decreases by 72 hours while CRP remains elevated. Sternal closure may affect CRP but not procalcitonin. Procalcitonin is independently associated with circulatory support requirements at 72 hours post-operation and development of infection. Procalcitonin may have greater utility as a biomarker in this population.Pediatric Research (2013); doi:10.1038/pr.2013.124.
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