Procalcitonin and Other Common Biomarkers Do Not Reliably Identify Patients at Risk for Bacterial Infection After Congenital Heart Surgery

Abstract

Objectives: Following surgery, it is difficult to distinguish a postoperative inflammatory reaction from infection. This study examined the predictive value of the biomarkers; procalcitonin, C-reactive protein, lactate, neutrophils, lymphocytes, platelets, and the biphasic activated partial thromboplastin time waveform in diagnosing bacterial infection following cardiac surgery. Design: Prospective, observational study. Setting: A regional, PICU in the United Kingdom. Patients: Three-hundred sixty-eight children under the age of 16 admitted to the PICU for elective cardiac surgery were enrolled in the study. Interventions: All biomarker measurements were determined daily until postoperative day 7. Children were assessed for postoperative infection until day 28 and divided into four groups: bacterial infection, culture-negative sepsis, viral infection, and no infection. We used the Kruskal-Wallis test, chi-square test, analysis of variance, and area under the curve in our analysis. Measurements and Main Results: In total, 71 of 368 children (19%) developed bacterial infection postoperatively, the majority being surgical site infections. In those with bacterial infection, procalcitonin was elevated on postoperative days 1–3 and the last measurement prior to event compared with those without bacterial infection. The most significant difference was the last measurement prior to event; 0.72 ng/mL in the bacterial infection group versus 0.13 ng/mL in the no infection group (for all groups; p < 0.001). Longitudinal profiles of all biomarkers were indistinct in the bacterial infection and nonbacterial infection groups except in those with culture-negative infections who had distinct procalcitonin kinetics on postoperative days 1–4. Children with culture-negative sepsis required longer ventilatory support and PICU stay and were more likely to develop complications than the other groups. Conclusions: None of the biomarkers studied within 3 days of infection distinguished between infection and postoperative inflammatory reaction. However, procalcitonin kinetics peaked on postoperative day 2 and fell more sharply than C-reactive protein kinetics, which peaked at postoperative day 3. The monitoring of procalcitonin kinetics following cardiac surgery may help guide rational antimicrobial use.

Prognostic value of biomarkers after cardiopulmonary bypass in pediatrics: The prospective PANCAP study

“…The incidence of IBI in children after CPB in this study is similar to previous published studies [46–49]. PCT was more useful as a diagnostic biomarker of infectious complication than as a prognostic biomarker.…”

NMR-based metabolic profiling provides diagnostic and prognostic information in critically ill children with suspected infection

“…Additionally, we examined metabolite changes with organ dysfunction, which is now a key component of the new sepsis definition 1 . Previous studies, including our own 24 have failed to show significant differences in single biomarkers between postoperative cardiac surgery patients with and without infection, and this study demonstrates that metabolic profiles are different between these groups. Limitations of our study include the fact that the number of patients with definite bacterial infection was low, and those with sepsis (infection with organ dysfunction) was even lower.…”

Optimizing the Use of Antibiotic Agents in the Pediatric Intensive Care Unit: A Narrative Review

“…In a PICU population, neither single nor serial measurements could predict presence or absence of bacterial infection with enough certainty to start or withhold antibiotic treatment [30]. PCT has been extensively studied in critically ill children after congenital heart surgery, where it failed to distinguish postoperative infection from inflammation [31].…”