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C-reactive protein and procalcitonin after congenital heart surgery utilizing cardiopulmonary bypass: When should we
Juan S Farias1, Enrique G Villarreal1, Janhavi Dhargalkar2
1Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico.
Insights
Procalcitonin (PCT) and C-reactive protein (CRP) are biomarkers used to identify infection in children after congenital heart surgery (CHS). PCT shows a greater significant difference in detecting infection compared to CRP.
Area of Science:
- Biomarkers
- Pediatric Cardiology
- Infectious Disease
Background:
- Postoperative infection is a significant concern in children following congenital heart surgery (CHS) with cardiopulmonary bypass (CPB).
- Accurate and timely identification of infection is crucial for effective management and improved patient outcomes.
Purpose of the Study:
- To evaluate the diagnostic efficacy of C-reactive protein (CRP) and procalcitonin (PCT) in detecting infection in pediatric patients after CHS with CPB.
- To compare the performance of CRP and PCT in identifying infection in this specific patient population.
Main Methods:
- A systematic review of existing literature was performed to identify relevant studies.
- Studies included children who underwent CHS with CPB, analyzing CRP and PCT levels at various postoperative timepoints.
- Subset analyses were conducted to compare biomarker levels in patients with and without documented infections.
Main Results:
- The review included 21 studies for CRP (1655 patients) and 9 studies for PCT (882 patients).
- Both CRP and PCT peaked on postoperative Day 2.
- Procalcitonin demonstrated a statistically significant difference between infected and non-infected groups on postoperative Days 1, 2, and 3 (12.9 ng/ml vs. 5.6 ng/ml), whereas CRP showed a significant difference only on Day 4 (53.60 mg/L vs. 29.68 mg/L).
Conclusions:
- Both CRP and PCT levels rise after CHS with CPB, peaking on postoperative Day 2.
- Procalcitonin is a more sensitive biomarker than CRP for early detection of infection in this cohort.
- A PCT level exceeding 5.6 ng/ml should prompt suspicion for infection in children post-CHS with CPB.
Introduction:
To assess the efficacy of C-reactive protein (CRP) and procalcitonin (PCT) at identifying infection in children after congenital heart surgery (CHS) with cardiopulmonary bypass (CPB).
Materials And Methods:
Systematic review of the literature was conducted to identify studies with data regarding CRP and/or PCT after CHS with CPB. The primary variables identified to be characterized were CRP and PCT at different timepoints. The main inclusion criteria were children who underwent CHS with CPB. Subset analyses for those with and without documented infection were conducted in similar fashion. A p value of less than .05 was considered statistically significant.
Results:
A total of 21 studies were included for CRP with 1655 patients and a total of 9 studies were included for PCT with 882 patients. CRP peaked on postoperative Day 2. A significant difference was noted in those with infection only on postoperative Day 4 with a level of 53.60 mg/L in those with documented infection versus 29.68 mg/L in those without. PCT peaked on postoperative Day 2. A significant difference was noted in those with infection on postoperative Days 1, 2, and 3 with a level of 12.9 ng/ml in those with documented infection versus 5.6 ng/ml in those without.
Conclusions:
Both CRP and PCT increase after CHS with CPB and peak on postoperative day 2. PCT has a greater statistically significant difference in those with documented infection when compared to CRP and a PCT of greater than 5.6 ng/ml should raise suspicion for infection.
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