Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-16T16:13:20.441Z Has data issue: false hasContentIssue false
  • English
  • Français

Kinetics of procalcitonin, interleukin 6 and C-reactive protein after cardiopulmonary-bypass in children

Published online by Cambridge University Press:  18 April 2005

Maurice Beghetti ,
Peter C. Rimensberger ,
Afksendiyos Kalangos ,
Walid Habre  and
Alain Gervaix
Maurice Beghetti
Affiliation:
Cardiology Unit, University Hospital Geneva, Switzerland
Peter C. Rimensberger
Affiliation:
Intensive Care Division, University Hospital Geneva, Switzerland
Afksendiyos Kalangos
Affiliation:
Cardiovascular Clinic, Department of Surgery, University Hospital Geneva, Switzerland
Walid Habre
Affiliation:
Anesthesiology Unit, Department of Anesthesia, University Hospital Geneva, Switzerland
Alain Gervaix
Affiliation:
Infectious Disease, Department of Pediatrics, University Hospital Geneva, Switzerland
Get access Rights & Permissions [Opens in a new window]

Abstract

Cardiopulmonary bypass induces a generalized inflammatory response, with fever and leukocytes, which is difficult to differentiate from an infection. Recently, procalcitonin has been proposed as an early and specific marker of bacterial infection. The influence of cardiopulmonary bypass on production of procalcitonin, therefore, must be assessed before considering this molecule as a valuable marker of infection after cardiac surgery in children. With this in mind, we measured levels of procalcitonin, interleukin 6, and C-reactive protein before and 6 h, 1, 3 and 5 days after cardiopulmonary bypass, in 25 children undergoing cardiac surgery. Cardiopulmonary-bypass induced a transient increase in procalcitonin, with a peak at 24 h, with a median of 1.13 μg/l, a 25th and 75th interquartile of 0.68–2.25, and a p value of less than 0.001. The value had returned to normal in the majority of the children by the third day after surgery. Peak values correlated with the duration of cardiopulmonary-bypass, with a r-value of 0.58 and a p value of 0.003; cross-clamp time, with a r-value of 0.62 and a p value of 0.001; days of mechanical ventilation, with a r-value of 0.62 and a p value of 0.001; and days of stay in intensive care, with a r-value of 0.68, and a p value of 0.0003. The value returned to normal after 3 days in 83% of the patients. Levels of interleukin 6 and C-reactive protein also increased significantly after surgery, and remained elevated for up to 5 days.

Thus, in contrast to other markers, levels of procalcitonin in the serum are only slightly and transiently influenced by cardiopulmonary bypass, and may prove to be useful in the early recognition of an infection subsequent to cardiopulmonary bypass.

Keywords

Complementheart surgerypediatricsintensive care
Type
Original Article
Information
Cardiology in the Young , Volume 13 , Issue 2 , April 2003 , pp. 161 - 167
Copyright
© 2003 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Source of support: Immunoluminometric assays for procalcitonin (LUMItest PCT, Brahms Diagnostica, Berlin, Germany) were provided by Brahms Diagnostica.

References

Kirklin JK, Westaby S, Blackstone EH, Kirklin JW, Chenoweth DE, Pacifico AD. Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg 1983; 86: 856–857.Google Scholar
Butler J, Rocker GM, Westaby S. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 1993; 55: 552–559.Google Scholar
Hall RI, Smith MS, Rocker G. The systemic inflammatory response to cardiopulmonary bypass: pathophysiological, therapeutic, and pharmacological considerations. Anesth Analg 1997; 85: 766–782.Google Scholar
Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 1993; 3 (41): 515–518.Google Scholar
Oczenski W, Fitzgerald RD, Schwarz S. Procalcitonin: a new parameter for the diagnosis of bacterial infection in the peri-operative period. Eur J Anaesthesiol 1998; 15: 202–209.Google Scholar
Chiesa C, Pacifico L, Mancuso G, Panero A. Procalcitonin in pediatrics: overview and challenge. Infection 1998; 26: 236–241.Google Scholar
Dandona P, Nix D, Wilson MF, et al. Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrin Metab 1994; 79: 1605–1608.Google Scholar
Brunkhorst FM, Heinz U, Forycki ZF. Kinetics of procalcitonin in iatrogenic sepsis. Intensive Care Med 1998; 24: 888–892.Google Scholar
Meisner M, Tschaikowsky K, Hutzler A, Schick C, Schüttler J. Postoperative plasma concentrations of procalcitonin after different types of surgery. Intensive Care Med 1998; 24: 680–684.Google Scholar
Mimoz O, Benoist JF, Edouard AR, Assicot M, Bohuon C, Samii K. Procalcitonin and C-reactive protein during the early postraumatic systemic inflammatory response syndrome. Intensive Care Med 1998; 24: 185–188.Google Scholar
Gendrel D, Assicot M, Raymond J, Moulin F, Francoual C, Bohuon C. Procalcitonin as a marker for the early diagnosis of neonatal infection. J Pediatr 1996; 128: 570–573.Google Scholar
Adamik B, Kubler-Kielb J, Golebiowska B, Gamian A, Kubler A. Effect of sepsis and cardiac surgery with cardiopulmonary bypass on plasma level of nitric oxide metabolites, neopterin, and procalcitonin: correlation with mortality and postoperative complications. Intensive Care Med 2000; 26: 1259–1267.Google Scholar
Hensel M, Volk T, Döcke WD, et al. Hyperprocalcitoninemia in patients with noninfectious SIRS and pulmonary dysfunction associated with cardiopulmonary bypass. Anesthesiology 1998; 89: 93–104.Google Scholar
Meisner M, Rauschmayer C, Schmidt J, et al. Early increase of procalcitonin after cardiovascular surgery in patients with postoperative complications. Intensive Care Med 2002; 28: 1094–1102.Google Scholar
Kilger ER, Pichler B, Goetz AE, et al. Procalcitonin as a marker of systemic inflammation after conventional or minimal invasive coronary artery bypass grafting. Thorac Cardiovasc Surg 1998; 46: 130–133.Google Scholar
Loebe M, Locziewski S, Brunkhorst FM, Harke C, Hetzer R. Procalcitonin in patients undergoing cardiopulmonary bypass in open heart surgery-first results of the procalcitonin in Heart Surgery Study (Prohearts). Intensive Care Med 2000; 26 (Suppl 2): S 193.Google Scholar
Rothenburger M, Markevitz A, Lenz T, et al. Detection of acute phase response and infection. The role of procalcitonin and C-reactive protein. Clin Chem Lab Med 1999; 37: 275–279.Google Scholar
Casey WF, Hauser GJ, Hannallah RS, Midgley FM, Khan WN. Circulating endotoxin and tumor necrosis factor during pediatric cardiac surgery. Crit Care Med 1992; 20: 1090–1096.Google Scholar
Aronen M, Leijala M, Meri S. Value of C-reactive protein in reflecting the magnitude of complement activation in children undergoing open heart surgery. Intensive Care Med 1990; 6: 128–132.Google Scholar
Aronen M. Value of C-reactive protein in detecting complications after open-heart surgery in children. Scand J Thorac Cardiovasc Surg 1990; 24: 141–145.Google Scholar
Hauser GJ, Ben-Ari J, Colvin MP, et al. Interleukin-6 levels in serum and lung lavage fluid of children undergoing open heart surgery correlates with postoperative morbidity. Intensive Care Med 1998; 24: 481–486.Google Scholar
Butler J, Chong GL, Baigrie RJ, Pillai R, Westaby S, Rocker GM. Cytokine responses to cardiopulmonary bypass with membrane and bubble oxygenation. Ann Thorac Surg 1992; 53: 833–838.Google Scholar
Cremer J, Martin M, Redl H, et al. Systemic inflammatory response syndrome after cardiac operation. Ann Thorac Surg 1996; 61: 1714–1720.Google Scholar
Werra I, Jaccard C, Corradin SB, et al. Cytokines, nitrite/nitrate, soluble tumor necrosis factor receptors and procalcitonin concentrations: comparison in patients with septic shock, cardiogenic shock and bacterial pneumonia. Crit Care Med 1997; 25: 607–613.Google Scholar
Nylen ES, Whang KT, Snider RH, Steinwald PM, White JC, Becker KL. Mortality is increased by procalcitonin and decreased by an antiserum reactive to procalcitonin in experimental sepsis. Crit Care Med 1998; 26: 1001–1006.Google Scholar