C‐reactive protein and procalcitonin after congenital heart surgery utilizing cardiopulmonary bypass: When should we be worried?

Farias, Juan; Villarreal, Enrique G.; Dhargalkar, Janhavi; Kleinhans, Alicia; Flores, Saúl; Loomba, Rohit S.

doi:10.1111/jocs.15952

Cited by 9 publications

(9 citation statements)

References 44 publications

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“…The cut-off levels were also considerably lower compared to other studies (0.73 mg/L and 1.085 mg/l on the first and third day, respectively). Farias et al reported 12.9 ng/ml cut-off in the infection group compared to 5.6 ng/ml in the non-infection group on the first day post-cardiac surgery; and 15 ng/ml (infection group) compared to 3.6 ng/ml (non-infection group) on the third day post-cardiac surgery ( 28 ). The difference might be attributed to various type of surgeries in our study, which could lead to varying degrees of post-operative inflammation.…”

Section: Discussionmentioning

confidence: 99%

Presepsin as a promising biomarker for early detection of post-operative infection in children

et al. 2023

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BackgroundPost-operative systemic inflammation response syndrome (SIRS) is an event that results from surgical trauma, white blood cells contact activation, and intra-surgical bacterial translocation, which is difficult to distinguish from sepsis. Presepsin is a novel biomarker that is increased since the early stages of bacterial infection and can be used to confirm the diagnosis of post-operative infectious complications. This study aimed to investigate the diagnostic performance of presepsin for post-operative infectious complications compared to other well-known biomarkers.MethodThis cross-sectional study included 100 post-operative patients admitted to Cipto Mangunkusumo National Hospital and Bunda Hospital in Jakarta, Indonesia. The objective was to identify the optimal cutoff and trend of plasma presepsin concentration on the first and third day after surgery and to compare them with other biomarkers.ResultPlasma presepsin level was higher in the infection group compared to the non-infection group (median 806.5 pg/ml vs. 717 pg/ml and 980 pg/ml vs. 516 pg/ml on the first and third day, respectively). Presepsin levels tended to increase on the third post-operative day (median + 252 pg/ml) in children with infection. The opposite trend was observed in the non-infection group from the first to the third day (median -222.5 pg/ml). Presepsin delta, a three-day difference between the first and third post-operative day, had the best diagnostic performance compared to other biomarkers (Area Under the Curve 0.825). The optimal cutoff for presepsin delta to diagnose post-operative infection was +90.5 pg/ml.ConclusionSerial assessments of presepsin levels on the first and third days post-surgery and their trends are helpful diagnostic markers for clinicians to detect post-operative infectious complications in children.

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Section: Discussionmentioning

confidence: 99%

Presepsin as a promising biomarker for early detection of post-operative infection in children

et al. 2023

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“…Currently, the most widely used acute phase marker is CRP, a short pentraxin produced during a systemic inflammatory response (Doni et al, 2017 ). However, due to its kinetics (slow rise and long time to normalization), it is of limited value in postoperative monitoring, and studies have shown that PCT performs better in this setting (Farias et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Postoperative kinetics of pentraxin 3 (PTX3) after congenital heart surgery with cardiopulmonary bypass in pediatric patients

Jaworski

Dzierżanowska-Fangrat

Grzywa-Czuba

et al. 2022

Perioper Med

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Background Pentraxins are inflammatory proteins and markers of acute-phase responses. They are divided into short and long subgroups based on the length of the N-terminal region. The most studied short pentraxin is the C-reactive protein (CRP), which is known to be expressed in various inflammatory conditions, including surgical procedures. On the other hand, much less is known about the kinetics of long pentraxin 3 (PTX3) in surgical patients, especially in the pediatric population. The aim of this prospective study was to determine the early postoperative kinetics of PTX3 in relation to procalcitonin (PCT) and CRP levels in children undergoing congenital heart surgery with cardiopulmonary bypass (CPB). Methods A total of 21 children (9 boys and 12 girls, mean age 12 months) were included in the study. Blood samples for determination of CRP, PCT, and PTX3 levels were collected before the surgery and then immediately after its completion (postoperative day 0, POD 0) and subsequently at POD 1, 2, and 3. Results Serum PTX3 concentrations increased significantly between POD 0 and POD 1 (mean values were 12.2 and 72.4 ng/ml, respectively, p<0.001), decreased between POD 1 and POD 2 (mean values were 72.4 and 23.6 ng/ml, respectively, p<0.001), and normalized on POD 3 (the mean value was 1.2 ng/ml). Conclusions PTX3 concentrations are markedly elevated during the first postoperative day. Under normal circumstances, PTX3 rises and falls quickly, and its second rise in the early postoperative period may be abnormal, however, further studies are necessary.

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“…Studies in the pediatric cardiac surgical population have shown the variable utility of CRP and procalcitonin to differentiate between inflammation and severe sepsis in the first week after cardiopulmonary bypass. [29][30][31] We hypothesized that these data would give providers more confidence to stop antibiotics at 24 hours. Although it was underpowered, our exploratory analysis did not reveal absolute values or changes in baseline values that definitively differentiated patients with infection from those without.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a 24-hour infection diagnosis protocol in the pediatric cardiac intensive care unit (CICU)

Chitalia

Benscoter

Chlebowski

et al. 2022

Infect. Control Hosp. Epidemiol.

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Objectives: To reduce unnecessary antibiotic exposure in a pediatric cardiac intensive care unit (CICU). Design: Single-center, quality improvement initiative. Monthly antibiotic utilization rates were compared between 12-month baseline and 18-month intervention periods. Setting: A 25-bed pediatric CICU. Patients: Clinically stable patients undergoing infection diagnosis were included. Patients with immunodeficiency, mechanical circulatory support, open sternum, and recent culture-positive infection were excluded. Interventions: The key drivers for improvement were standardizing the infection diagnosis process, order-set creation, limitation of initial antibiotic prescription to 24 hours, discouraging indiscriminate vancomycin use, and improving bedside communication and situational awareness regarding the infection diagnosis protocol. Results: In total, 109 patients received the protocol; antibiotics were discontinued in 24 hours in 72 cases (66%). The most common reasons for continuing antibiotics beyond 24 hours were positive culture (n = 13) and provider preference (n = 13). A statistical process control analysis showed only a trend in monthly mean antibiotic utilization rate in the intervention period compared to the baseline period: 32.6% (SD, 6.1%) antibiotic utilization rate during the intervention period versus 36.6% (SD, 5.4%) during the baseline period (mean difference, 4%; 95% CI, −0.5% to −8.5%; P = .07). However, a special-cause variation represented a 26% reduction in mean monthly vancomycin use during the intervention period. In the patients who had antibiotics discontinued at 24 hours, delayed culture positivity was rare. Conclusions: Implementation of a protocol limiting empiric antibiotic courses to 24 hours in clinically stable, standard-risk, pediatric CICU patients with negative cultures is feasible. This practice appears safe and may reduce harm by decreasing unnecessary antibiotic exposure.

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C‐reactive protein and procalcitonin after congenital heart surgery utilizing cardiopulmonary bypass: When should we be worried?

Cited by 9 publications

References 44 publications

Presepsin as a promising biomarker for early detection of post-operative infection in children

Presepsin as a promising biomarker for early detection of post-operative infection in children

Postoperative kinetics of pentraxin 3 (PTX3) after congenital heart surgery with cardiopulmonary bypass in pediatric patients

Implementation of a 24-hour infection diagnosis protocol in the pediatric cardiac intensive care unit (CICU)

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