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Procalcitonin and Early Postoperative Infection After Pediatric Cardiopulmonary Bypass Surgery
Simona Silvetti1, Rosalba Lembo2, Alessio Mesini3
1Neonatal and Pediatric Intensive Care Unit, Department of Surgery and Critical Care, IRCCS Istituto Giannina Gaslini, Genova, Italy.
Insights
Procalcitonin (PCT) measured 48 hours after pediatric cardiac surgery may help predict postoperative infections. This marker showed promise in identifying infections, unlike white blood cell count or C-reactive protein.
Area of Science:
- Pediatric cardiac surgery
- Infectious disease diagnostics
- Biomarker research
Background:
- Systemic inflammation and bacterial infections are common post-pediatric cardiac surgery.
- Elevated white blood cell count and C-reactive protein lack specificity in early diagnosis.
- Distinguishing infection from inflammation is crucial for timely treatment.
Purpose of the Study:
- To evaluate procalcitonin (PCT) as a potential biomarker for early postoperative infection detection.
- To assess PCT levels within 48 hours after pediatric cardiac surgery.
- To compare PCT with traditional inflammatory markers.
Main Methods:
- Retrospective observational study of 177 pediatric patients undergoing cardiac surgery.
- Measurement of PCT, white blood cell count, and C-reactive protein at ICU admission, 24, and 48 hours post-surgery.
- Recording of positive cultures within seven days post-surgery.
Main Results:
- 12% of patients developed infections within seven days.
- Procalcitonin (PCT) at 48 hours post-surgery was the sole laboratory predictor of infection (p=0.02).
- Optimal PCT cut-off at 48 hours was 1.85 ng/mL, with AUC 0.63, sensitivity 63%, and specificity 69%.
Conclusions:
- Procalcitonin (PCT) shows promise as a predictive marker for postoperative infections in pediatric cardiac surgery patients.
- Further validation in larger cohorts is needed to confirm clinical relevance and predictive accuracy.
- PCT may aid in differentiating infection from systemic inflammation.
Objectives:
Systemic inflammation and bacterial infections are critical occurrences after pediatric cardiac surgery. Elevated white blood cell count and C-reactive protein cannot discriminate between these two conditions in the early postoperative period. The aim of this study was to understand whether procalcitonin (PCT) values within 48 hours of surgery could be a useful marker of postoperative infection.
Design:
Retrospective observational study.
Setting:
The study was performed in a teaching hospital.
Participants:
All patients ≤six years of age.
Interventions:
Cardiac surgery on cardiopulmonary bypass from January 1, 2017 to January 1, 2020.
Measurement And Main Results:
PCT, white blood cell count, and C-reactive protein values were measured at intensive care unit admission and at 24 and 48 hours after surgery. All positive cultures in the first seven days after surgery were recorded. Out of 177 consecutive patients, 22 (12%) developed infections. PCT at 48 hours after surgery was the only laboratory predictor of infections in the first seven days after surgery (p = 0.02). Receiver operating curve analyses on PCT values at 48 hours identified an optimal cut-off value of 1.85 ng/mL in the overall population. Area under the curve was 0.63, sensitivity 63%, and specificity 69%.
Conclusions:
In light of this preliminary result, the clinical relevance and predictive accuracy of PCT are promising in patients with increasing values of PCT but need to be confirmed in a larger sample.
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