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Markedly elevated procalcitonin in early postoperative period in pediatric open heart surgery: a prospective cohort
Etsuko Minami1, Shoji Ito2, Takeshi Sugiura1
1Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601 Japan.
Insights
Elevated procalcitonin (PCT) in pediatric cardiac surgery patients is linked to longer surgery and bypass times. Higher PCT may predict postoperative severity and organ dysfunction.
Area of Science:
- Cardiology
- Pediatric Surgery
- Critical Care Medicine
Background:
- Elevated procalcitonin (PCT) is frequently observed in pediatric patients post-open heart surgery.
- Understanding factors associated with PCT elevation is crucial for managing these patients.
Purpose of the Study:
- To investigate factors associated with elevated procalcitonin (PCT) in pediatric patients during the early postoperative period after open heart surgery.
Main Methods:
- Fifty-two pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) were enrolled.
- Plasma PCT, liver enzymes (AST/ALT), creatinine, lactate, and CRP were measured.
- Patients were grouped based on peak PCT levels (high vs. low).
- Aorta cross-clamp (ACC) time, CPB time, ICU stay, ventilation duration, and biomarker levels were compared between groups.
Main Results:
- Patients with higher peak PCT (group H) had significantly longer ACC and CPB times, ICU stays, and mechanical ventilation periods compared to the low PCT group (group L).
- Group H also exhibited significantly higher peak AST and creatinine levels than group L.
- p < 0.01 for duration metrics; p < 0.05 for biomarker levels.
Conclusions:
- Perioperative stress, indicated by aorta cross-clamp and CPB times, is associated with elevated PCT.
- Elevated PCT correlates with longer ICU stays, mechanical ventilation, and increased liver enzymes and creatinine.
- PCT may serve as a valuable predictor of postoperative severity and organ dysfunction in pediatric cardiac surgery patients.
Background:
We encountered markedly elevated procalcitonin (PCT) among pediatric patients during the early postoperative period of open heart surgery. The purpose of this study is to investigate what factors are associated with the PCT elevation.
Methods:
Fifty-two pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) were enrolled. Plasma PCT, aspartate aminotransferase/alanine aminotransferase (AST/ALT), creatinine, lactate, and C-reactive protein (CRP) were measured on admission to ICU and during the postoperative period. The patients were categorized into high (group H) and low (group L) groups according to their peak PCT levels. Aorta cross-clamp (ACC), CPB time, ICU stay, mechanical ventilation period, peak AST/ALT, creatinine, lactate, and CRP levels were compared.
Results:
ACC and CPB times, ICU stay period, and mechanical ventilation period were significantly longer in group H compared with group L (118.7 ± 51.6 vs. 49.4 ± 43.5 min, 244.5 ± 65.7 vs. 122.9 ± 63.0 min, 7.9 ± 4.6 vs. 4.0 ± 4.5 days, and 6.3 ± 4.1 vs. 2.9 ± 4.2 days, respectively; p < 0.01). Peak AST and creatinine were significantly higher in group H compared with group L (999.0 ± 1,990.3 vs. 88.3 ± 43.0 U/l and 0.84 ± 0.77 vs. 0.41 ± 0.17 mg/dl, respectively; p < 0.05).
Conclusions:
ACC and CPB time-related perioperative stress is associated with elevated PCT; an association between ICU stay and mechanical ventilation period, liver enzymes, and creatinine levels was observed. PCT may be a good predictor of postoperative severity and organ dysfunction.
