Procalcitonin Concentration Measured Within the First Days of Cardiac Surgery Is Predictive of Postoperative...

Area of Science:

• Biomarkers in Neonatal Care
• Infectious Disease Diagnostics
• Pediatric Cardiac Surgery

Background:

• Systemic inflammatory response after cardiopulmonary bypass (CPB) can complicate infection identification.
• Procalcitonin (PCT) is a more reliable infection marker than C-reactive protein (CRP) in this setting.
• Early and accurate detection of postoperative infections in neonates is critical.

Purpose of the Study:

• To evaluate the efficacy of neonate procalcitonin (PCT) in identifying infections post-cardiac surgery.
• To compare the predictive accuracy of PCT versus CRP for early postoperative infections.
• To establish optimal cutoff thresholds for PCT and CRP in predicting infections.

Main Methods:

• Retrospective case-control study involving 144 neonates undergoing cardiac surgery.
• PCT levels were matched between infected and non-infected patients based on age, CPB length, deep hypothermic circulatory arrest (DHCA), and postoperative day (POD).
• Accuracy of PCT and CRP in predicting infections was assessed, with specific attention to POD 1-4.

Main Results:

• PCT was a good predictor of infections up to POD 4 and superior to CRP on POD 1 and 2.
• A combined PCT and CRP threshold predicted infections with 68% sensitivity and 82% specificity on POD 1-2.
• Higher thresholds on POD 3-4 achieved 82% sensitivity and 93% specificity.
• PCT was not predictive in patients who underwent DHCA.

Conclusions:

• Procalcitonin (PCT) demonstrates superior accuracy to C-reactive protein (CRP) for early infection detection after neonatal cardiac surgery.
• The combined use of PCT and CRP significantly enhances the prediction of postoperative infections within the first four days.
• Further research may be needed to clarify PCT's role in neonates who undergo deep hypothermic circulatory arrest.