Procalcitonin versus C-reactive protein and immature-to-total neutrophil ratio as markers of infection after cardiopulmonary bypass in children

McMaster, Paddy; Park, Dong Young; Shann, Frank; Cochrane, Andrew; Morris, Kevin; Gray, J.; Cottrell, Serena; Belcher, John

doi:10.1097/pcc.0b013e31819369f3

Cited by 35 publications

(39 citation statements)

References 14 publications

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“…Hence, the individual patient, who may already clinically show signs of a local infection, will likely have higher odds of infection than the predicted ‘baseline’ risk stated in this paper. However, aspecific clinical symptoms such as fever or a high C-reactive protein level after cardiac surgery fail to predict occurrence of an infection, which underlines the need for a reliable prediction rule [37]. …”

Section: Discussionmentioning

confidence: 99%

Bedside prediction rule for infections after pediatric cardiac surgery

et al. 2012

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PurposeInfections after pediatric cardiac surgery are a common complication, occurring in up to 30% of cases. The purpose of this study was to develop a bedside prediction rule to estimate the risk of a postoperative infection.MethodsAll consecutive pediatric cardiac surgery procedures between April 2006 and May 2009 were retrospectively analyzed. The primary outcome variable was any postoperative infection, as defined by the Center of Disease Control (2008). All variables known to the clinician at the bedside at 48 h post cardiac surgery were included in the primary analysis, and multivariable logistic regression was used to construct a prediction rule.ResultsA total of 412 procedures were included, of which 102 (25%) were followed by an infection. Most infections were surgical site infections (26% of all infections) and bloodstream infections (25%). Three variables proved to be most predictive of an infection: age less than 6 months, postoperative pediatric intensive care unit (PICU) stay longer than 48 h, and open sternum for longer than 48 h. Translation into prediction rule points yielded 1, 4, and 1 point for each variable, respectively. Patients with a score of 0 had 6.6% risk of an infection, whereas those with a maximal score of 6 had a risk of 57%. The area under the receiver operating characteristic curve was 0.78 (95% confidence interval 0.72–0.83).ConclusionsA simple bedside prediction rule designed for use at 48 h post cardiac surgery can discriminate between children at high and low risk for a subsequent infection.

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Section: Discussionmentioning

confidence: 99%

Bedside prediction rule for infections after pediatric cardiac surgery

et al. 2012

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“…Although still few in number, studies are being conducted on the use of PCT in situations requiring the differentiation of SIRS from sepsis, including in patients in cardiac surgery post-operative care, (39,40) wherein the use of antibiotics may aggravate nephrotoxicity in patients subjected to intraoperative extracorporeal circulation. The use of PCT testing in severe burn victims has also been assessed, although its use as a predictor of infection or mortality in burned children is still limited.…”

Section: Introductionmentioning

confidence: 99%

Use of biomarkers in pediatric sepsis: literature review

Lanziotti

Póvoa

Soares

et al. 2016

Revista Brasileira De Terapia Intensiva

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Despite advances in recent years, sepsis is still a leading cause of hospitalization and mortality in infants and children. The presence of biomarkers during the response to an infectious insult makes it possible to use such biomarkers in screening, diagnosis, prognosis (risk stratification), monitoring of therapeutic response, and rational use of antibiotics (for example, the determination of adequate treatment length). Studies of biomarkers in sepsis in children are still relatively scarce. This review addresses the use of biomarkers in sepsis in pediatric patients with emphasis on C-reactive protein, procalcitonin, interleukins 6, 8, and 18, human neutrophil gelatinase, and proadrenomedullin. Assessment of these biomarkers may be useful in the management of pediatric sepsis.

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“…Although our findings of a relationship between greater CRP, leukocyte count and conversion in the first two days of the postoperative course hints at a possible role of intraoperative initiation of the immune system, these laboratory results have already failed at predicting the occurrence of infection [36]. The association between high CRP and leukocyte levels and infection might be explained as an augmented reaction to CPB and infective agents.…”

Section: Discussionmentioning

confidence: 70%

Postoperative differences between colonization and infection after pediatric cardiac surgery-a propensity matched analysis

Lex

Cserép

Breuer

et al. 2013

J Cardiothorac Surg

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BackgroundThe objective of this study was to identify the postoperative risk factors associated with the conversion of colonization to postoperative infection in pediatric patients undergoing cardiac surgery.MethodsFollowing approval from the Institutional Review Board, patient demographics, co-morbidities, surgery details, transfusion requirements, inotropic infusions, laboratory parameters and positive microbial results were recorded during the hospital stay, and the patients were divided into two groups: patients with clinical signs of infection and patients with only positive cultures but without infection during the postoperative period. Using propensity scores, 141 patients with infection were matched to 141 patients with positive microbial cultures but without signs of infection. Our database consisted of 1665 consecutive pediatric patients who underwent cardiac surgery between January 2004 and December 2008 at a single center. The association between the patient group with infection and the group with colonization was analyzed after propensity score matching of the perioperative variables.Results179 patients (9.3%) had infection, and 253 patients (15.2%) had colonization. The occurrence of Gram-positive species was significantly greater in the colonization group (p = 0.004). The C-reactive protein levels on the first and second postoperative days were significantly greater in the infection group (p = 0.02 and p = 0.05, respectively). The sum of all the positive cultures obtained during the postoperative period was greater in the infection group compared to the colonization group (p = 0.02). The length of the intensive care unit stay (p < 0.001) was significantly longer in the infection group compared to the control group.ConclusionsBased on our results, we uncovered independent relationships between the conversion of colonization to infection regarding positive S. aureus and bloodstream results, as well as significant differences between the two groups regarding postoperative C-reactive protein levels and white blood cell counts.

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Procalcitonin versus C-reactive protein and immature-to-total neutrophil ratio as markers of infection after cardiopulmonary bypass in children

Abstract: CRP was a poor marker of sepsis in this study. Children with a PCT <2.2 ng/mL or ITR <0.08 were unlikely to have definite or probable sepsis. However, only a third of children with high values of PCT and ITR had definite or probable sepsis.

Cited by 35 publications

References 14 publications

Bedside prediction rule for infections after pediatric cardiac surgery

Bedside prediction rule for infections after pediatric cardiac surgery

Use of biomarkers in pediatric sepsis: literature review

Postoperative differences between colonization and infection after pediatric cardiac surgery-a propensity matched analysis

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