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Quantitative analysis of procalcitonin after pediatric cardiothoracic surgery
David E Michalik1, Brian W Duncan, Roger B B Mee
1Division of Pediatrics, Department of Pediatric and Congenital Heart Surgery, The Children's Hospital, The Cleveland Clinic, Cleveland, Ohio 44195, United States of America.
Insights
Peri-operative procalcitonin levels significantly increase in children after cardiac surgery, peaking at 48 hours. These elevated levels in non-infected children complicate its use as a bacterial infection marker.
Area of Science:
- Pediatric Cardiac Surgery
- Biomarkers
- Infectious Disease
Background:
- Procalcitonin (PCT) is a sensitive marker for bacterial infections.
- Systemic inflammation post-cardiopulmonary bypass can affect PCT levels in pediatric cardiac surgery patients.
- Accurate interpretation of PCT in this population requires understanding peri-operative changes.
Purpose of the Study:
- To determine peri-operative serum procalcitonin concentrations in non-infected children undergoing cardiac surgery.
- To assess the impact of cardiac surgery and cardiopulmonary bypass on PCT levels.
- To provide reference ranges for PCT in this specific clinical setting.
Main Methods:
- Serum samples collected from 53 pediatric patients at baseline, 24, 48, and 72 hours post-cardiac surgery.
- Procalcitonin concentrations measured using an immunoluminometric assay.
- Statistical analysis of PCT levels and their changes over time.
Main Results:
- Median PCT levels increased from <0.5 ng/mL at baseline to 1.8 ng/mL at 24 hours, peaking at 2.1 ng/mL at 48 hours, and decreasing to 1.3 ng/mL at 72 hours.
- PCT levels remained significantly elevated above baseline throughout the 72-hour post-operative period (p < 0.001).
- A subset of non-infected patients exhibited PCT levels substantially higher than the group median.
Conclusions:
- Serum procalcitonin concentrations significantly rise in children post-cardiac surgery, with peak levels at 48 hours.
- PCT levels do not normalize to baseline within 72 hours following surgery.
- Elevated PCT in the absence of infection in these patients necessitates careful interpretation.
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.