Procalcitonin

Jordan, Iolanda; Balaguer, Mònica; Torné, E. Esteban; Lasaosa, Francisco José Cambra; Viñas, Anna; Tolosa, C. Valls; Rico, A. Palomeque

doi:10.1097/pcc.0b013e31823890de

Cited by 29 publications

(18 citation statements)

References 26 publications

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“…[ 13 14 ] Consequently, proposed threshold levels for the identification of BI in prior studies have varied widely, from 0.38 ng/mL to 13 ng/mL, and several authors have suggested using different threshold values for different days or time periods. [ 16 17 18 19 ] In the current study, a PCT level of 2 ng/mL was found to be the optimal threshold value for discrimination of infection. Even at this threshold value, PCT is not highly sensitive or specific for infection.…”

Section: Discussionmentioning

confidence: 64%

“…PCT values on POD 1 were higher in the BI group than in the non-BI group without a statistically significant difference. [ 19 ] Similarly, McMaster et al . compared the median PCT on PODs 1-5 of patients with known infection to patients without fever or suspicion of infection after CHS.…”

Section: Discussionmentioning

confidence: 99%

“…[ 11 12 13 14 ] Nonetheless, its utility in differentiating between BI and SIRS in patients suspected of having infection at various postoperative time points remains unclear. [ 15 16 17 18 19 ] We aim to determine the optimal PCT level to distinguish between BI and SIRS in children suspected of having infection following CHS.…”

Section: Introductionmentioning

confidence: 99%

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Procalcitonin as a biomarker of bacterial infection in pediatric patients after congenital heart surgery

et al. 2016

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Background:Bacterial infection (BI) after congenital heart surgery (CHS) is associated with increased morbidity and is difficult to differentiate from systemic inflammatory response syndrome caused by cardiopulmonary bypass (CPB). Procalcitonin (PCT) has emerged as a reliable biomarker of BI in various populations.Aim:To determine the optimal PCT threshold to identify BI among children suspected of having infection following CPB.Setting and Design:Single-center retrospective observational study.Materials and Methods:Medical records of all the patients admitted between January 2013 and April 2015 were reviewed. Patients in the age range of 0-21 years of age who underwent CHS requiring CPB in whom PCT was drawn between postoperative days 0-8 due to suspicion of infection were included.Statistical Analysis:The Wilcoxon rank-sum test was used for nonparametric variables. The diagnostic performance of PCT was evaluated using a receiver operating characteristic (ROC) curve.Results:Ninety-eight patients were included. The median age was 2 months (25th and 75th interquartile of 0.1-7.5 months). Eleven patients were included in the BI group. The median PCT for the BI group (3.42 ng/mL, 25th and 75th interquartile of 2.34-5.67) was significantly higher than the median PCT for the noninfected group (0.8 ng/mL, 25th and 75th interquartile 0.38-3.39), P = 0.028. The PCT level that yielded the best compromise between the sensitivity (81.8%) and specificity (66.7%) was 2 ng/mL with an area under the ROC curve of 0.742.Conclusion:A PCT less than 2 ng/mL makes BI unlikely in children suspected of infection after CHS.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Procalcitonin as a biomarker of bacterial infection in pediatric patients after congenital heart surgery

et al. 2016

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“…Routine white blood cell (WBC) counts with neutrophil counts, platelet counts, CRP, and erythrocyte sedimentation rate (ESR) were collected from all patients presurgery, then on 4 consecutive days postsurgery, and then predischarge from ICU between day 5 and day 7 postsurgery. Although procalcitonin (PCT) was found to be better marker for sepsis evaluation in some studies,[ 10 11 ] it was not included in our study due to unavailability in our center. Intravenous cefuroxime postcardiac surgery was used routinely and continued until removal of chest drains usually between days 2 and 3 postoperatively.…”

Section: Methodsmentioning

confidence: 99%

Can acute-phase response biomarkers differentiate infection from inflammation postpediatric cardiac surgery?

et al. 2017

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Background:Infection is a common serious complication postpediatric cardiac surgery. Diagnosis of infection after cardiopulmonary bypass (CPB) is difficult in the presence of surgical stress, hemodynamic instability, and inflammatory reaction.Aim:The purpose of this study is to investigate the value of available inflammatory biomarkers and its validity to differentiate infection from inflammation postpediatric cardiac surgery and to find the trend and the change in the level of these biomarkers shortly after cardiac surgery.Methods:We conducted a prospective study that included all children who underwent cardiac surgery in Prince Sultan Cardiac Centre-Qassim from November 2013 to October 2015. C-reactive protein, erythrocyte sedimentation rate, white blood cell count, and neutrophil count were measured for all patients presurgery, 4 consecutive days postsurgery, and predischarge. Patients were divided into two groups (the infected and the noninfected group). We compared the level of biomarkers between both groups. Then, we further analyzed the effects of CPB and preoperative steroid on postoperative inflammatory biomarker levels. Collected data were then reviewed and analyzed.Results:There were 134 pediatric cardiac patients included during the study period. Group 1 (bacterial negative culture group) had 125 cases and Group 2 (bacterial positive culture group) had nine cases. We found no statistically significant difference in inflammatory biomarker elevation between both groups. Only Group 2 had higher (RACHS) Risk adjustment for congenital heart surgery score, more ventilator days, and more drop in platelet count on the 2nd and 3rd postoperative days in comparison with the noninfected group 1. Both groups of patients who were in on and off CPB had the same level of inflammatory biomarkers with no significant differences. Giving corticosteroid preoperatively did not affect the trend of biomarker elevation and made no difference when it was compared to the group of patients who did not receive corticosteroid before surgery.Conclusion:Common inflammatory biomarkers cannot differentiate between infection and inflammation within the first 5 days postpediatric cardiac surgery as these reflect the inflammatory process rather than infection. Trend is more important than single reading.

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“…Recent studies have shown that PCT may be useful for screening of bacterial sepsis after CS in children,1,3,4,12,13 but none of these studies focused on the newborn population. In contrast to older children, uninfected and healthy newborns can present higher PCT values during the first days of life, making it difficult to establish a cutoff value for PCT 14–16…”

Section: Introductionmentioning

confidence: 99%

Procalcitonin is a Better Biomarker than C-Reactive Protein in Newborns Undergoing Cardiac Surgery: The Prokineca Study

et al. 2016

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OBJECTIVESTo assess the kinetics of procalcitonin (PCT) and C-reactive protein (CRP) in newborns after cardiothoracic surgery (CS), with and without cardiopulmonary bypass, and to assess whether PCT was better than CRP in identifying sepsis in the first 72 hours after CS.PATIENTS AND METHODSThis is a prospective study of newborns admitted to the neonatal intensive care unit after CS.INTERVENTIONSPCT and CRP were sequentially drawn 2 hours before surgery and at 0, 12, 24, 48, and 72 hours after surgery.RESULTSA total of 65 patients were recruited, of which 14 were excluded because of complications. We compared the kinetics of PCT and CRP after CS in bypass and non-bypass groups without sepsis; there were no differences in the PCT values at any time (24 hours, P = 0.564; 48 hours, P = 0.117; 72 hours, P = 0.076). Thirty-five patients needed bypass, of whom four were septic (11.4%). Significant differences were detected in the PCT values on comparing the septic group to the nonseptic group at 48 hours after cardiopulmonary bypass (P = 0.018). No differences were detected in the CRP values in these groups. A suitable cutoff for sepsis diagnosis at 48 hours following bypass would be 5 ng/mL, with optimal area under the curve of 0.867 (confidence interval 0.709–0.958), P < 0.0001, and sensitivity and specificity of 87.5% (29.6–99.7) and 72.6% (53.5–86.4), respectively.CONCLUSIONThis is a preliminary study but PCT seems to be a good biomarker in newborns after CS. Values over 5 ng/mL at 48 hours after CS should alert physicians to the high risk of sepsis in these patients.

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Procalcitonin

Abstract: Procalcitonin is useful in the diagnosis of bacterial infection after cardiopulmonary bypass. Because procalcitonin kinetics are different in postcardiopulmonary bypass patients, the cutoff to diagnose infection should be different from the normal cutoff.

Cited by 29 publications

References 26 publications

Procalcitonin as a biomarker of bacterial infection in pediatric patients after congenital heart surgery

Procalcitonin as a biomarker of bacterial infection in pediatric patients after congenital heart surgery

Can acute-phase response biomarkers differentiate infection from inflammation postpediatric cardiac surgery?

Procalcitonin is a Better Biomarker than C-Reactive Protein in Newborns Undergoing Cardiac Surgery: The Prokineca Study

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