Quantitative analysis of procalcitonin after pediatric cardiothoracic surgery

Abstract

Procalcitonin appears to be an early and sensitive marker of bacterial infection in a variety of clinical settings. The use of levels of procalcitonin to predict infection in children undergoing cardiac surgery, however, may be complicated by the systemic inflammatory response that normally accompanies cardiopulmonary bypass. The aim of our study was to estimate peri-operative concentrations of procalcitonin in non-infected children undergoing cardiac surgery. Samples of serum for assay of procalcitonin were obtained in 53 patients at baseline, 24, 48, and 72 hours following cardiac surgery. Concentrations were assessed using an immunoluminetric technique. Median concentrations were lowest at baseline at less than 0.5 nanograms per millilitre, increased at 24 hours to 1.8 nanograms per millilitre, maximized at 48 hours at 2.1 nanograms per millilitre, and decreased at 72 hours to 1.3 nanograms per millilitre, but did not return to baseline levels. Ratios of concentrations between 24, 48 and 72 hours after surgery as compared to baseline were 6.15, with 95 percent confidence intervals between 4.60 and 8.23, 6.49, with 95 percent confidence intervals from 4.55 to 9.27, and 4.26, with 95 percent confidence intervals between 2.78 and 6.51, respectively, with a p value less than 0.001. In 8 patients, who had no evidence of infection, concentrations during the period from 24 to 72 hours were well above the median for the group. We conclude that concentrations of procalcitonin in the serum increase significantly in children following cardiac surgery, with a peak at 48 hours, and do not return to baseline within 72 hours of surgery. A proportion of patients, in the absence of infection, had exaggerated elevations post-operatively.

Kinetics of procalcitonin and C-reactive protein and the relationship to postoperative infection in young infants undergoing cardiovascular surgery

“…Post-operative increases in PCT in adults were generally small (0.5–7 ng/ml) (3) and close to suggested cut-offs for identifying bacterial infections in other settings (0.5–2 ng/ml) (18–20). In contrast, Michalik et al and Hammer et al reported occasional large increases in PCT (>50 ng/ml) in pediatric patients undergoing cardiothoracic surgery with cardiopulmonary bypass (12,15). Our study identified a substantial subset of patients (13%) who developed very high PCT levels (>20 ng/ml) by 24 hours post-operation.…”

“…Several prior studies of PCT and CRP after pediatric cardiothoracic surgery have included neonates and infants, but always in combination with older children (5–8, 11–15). Younger patients have immature immune responses and tend to have more complex surgeries, including longer bypass/aortic cross clamp times and the use of deep hypothermic circulatory arrest.…”

Untitled

“…Peak PCT values, measured by the immunoluminometric assay, range from 0.5 to 7.0 ng/ml [29,31-40,42-44,46-48]. …”

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

“…Few studies have described the normal post-operative procalcitonin serum-level kinetics after cardiopulmonary bypass in children. [10][11][12][13][14][15][16][17] According to these studies, the rate of procalcitonin rises to a maximum peak of 24-48 hours after the surgery and then decreases to a normal value after the third post-operative day. The purpose of this study was to evaluate the diagnostic value of procalcitonin as a marker of infection after cardiopulmonary bypass in children.…”

“…11 Threshold values that were previously identified as defining normality ranged from 1.1 to 2.2 nanograms per millilitre for the first post-operative days. [10][11][12][13][14][15] This difference is probably explained by the use of new definitions of paediatric infection, [18][19][20][21] whereas previous studies were based on older adult infection definitions (1992). 23 The distinction of several age groups with regard to clinical and constant biological values allows us more precision, whereas previous misclassification might have concerned cases of systemic inflammatory response syndrome.…”