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Procalcitonin and C-reactive protein kinetics in postoperative pediatric cardiac surgical patients
Ronaldo Arkader1, Eduardo Juan Troster, Deipara Monteiro Abellan
1Department of Pediatrics, School of Medicine, University of São Paulo, São Paulo, Brazil.
Insights
Procalcitonin (PCT) and C-reactive protein (CRP) levels were monitored after pediatric cardiac surgery. PCT showed a more favorable trend than CRP for monitoring patients with systemic inflammatory response syndrome.
Area of Science:
- Biochemistry
- Pediatric Critical Care Medicine
- Surgical Inflammation
Background:
- Pediatric cardiac surgery with cardiopulmonary bypass (CPB) can elicit a systemic inflammatory response.
- Monitoring inflammatory markers like procalcitonin (PCT) and C-reactive protein (CRP) is crucial for patient management.
Purpose of the Study:
- To investigate the concentration kinetics of PCT and CRP following pediatric cardiac surgery.
- To compare the utility of PCT and CRP in monitoring patients undergoing CPB.
Main Methods:
- Prospective clinical cohort study involving 14 pediatric patients.
- Serum PCT and CRP levels measured pre-CPB, post-CPB, and on postoperative days 1, 2, and 3.
- Immuno-luminometry and nephelometry used for PCT and CRP quantification, respectively.
Main Results:
- Both PCT and CRP increased immediately after CPB.
- PCT peaked at 24 hours postoperatively and then decreased, generally remaining within reference values.
- CRP levels significantly elevated post-CPB, persisting at higher concentrations through day 3.
Conclusions:
- PCT and CRP are elevated after CPB in pediatric cardiac surgery patients.
- PCT appears more effective than CRP in monitoring patients with systemic inflammatory response syndrome and favorable outcomes.
- PCT kinetics may offer a more sensitive indicator of inflammatory response post-pediatric cardiac surgery.
Objective:
To determine the kinetics of procalcitonin (PCT) and C-reactive protein (CRP) concentration after pediatric cardiac surgery with cardiopulmonary bypass.
Design:
Prospective, clinical cohort study.
Setting:
A fifteen-bed tertiary-care pediatric intensive care unit.
Patients:
Fourteen pediatric patients admitted for cardiac surgery.
Measurements And Main Results:
Serum PCT and CRP were measured before cardiopulmonary bypass (CPB); after CPB; and on the first, second, and third days after surgery by means of immunoluminometry and nephelometry, respectively. Reference values for systemic inflammatory response syndrome are 0.5 to 2.0 ng/mL for PCT and <5 mg/L for CRP. Baseline serum PCT and CRP concentrations were 0.24 +/- 0.13 ng/mL and 4.06 +/- 3.60 mg/L (median 25th percentile-75th percentile), respectively. PCT concentrations increased progressively from the end of CPB (0.62 +/- 0.30 ng/mL), peaked at 24 hours postoperatively (POD1) (0.77 +/- 0.49 ng/mL), and began to decrease at 48 hours or POD2 (0.35 +/- 0.21 ng/mL). CRP increased just after CPB (58.82 +/- 42.23 mg/L) and decreased after 72 hours (7.09 +/- 9.81 mg/L).
Conclusion:
An increment of both PCT and CRP was observed just after CPB. However, PCT values remained within reference values, whereas CRP concentrations increased significantly after CPB until the third day. These preliminary results suggest that PCT was more effective than CRP to monitor patients with SIRS and a favorable outcome.
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