Skip to main content
Erschienen in: Pediatric Cardiology 6/2019

16.07.2019 | Original Article

Procalcitonin Concentration Measured Within the First Days of Cardiac Surgery Is Predictive of Postoperative Infections in Neonates: A Case–Control Study

verfasst von: A. Aryafar, A. Di Marzio, O. Guillard, M. Pontailler, S. Vicca, M. Bojan

Erschienen in: Pediatric Cardiology | Ausgabe 6/2019

Einloggen, um Zugang zu erhalten

Abstract

Increased procalcitonin concentration (PCT) is known to be reliable for the identification of infections even in the presence of the non-specific systemic inflammatory response seen after cardiopulmonary bypass (CPB), whereas increased C-reactive protein concentration (CRP) is not. The present work explored the ability of neonate PCT measured early after cardiac surgery to identify postoperative infections. This was a retrospective case–control study, where PCT was matched between patients with and without infections according to the patient’s age, the CPB length, the use of deep hypothermic circulatory arrest (DHCA), and the postoperative day (POD). The accuracy in the prediction of infections was ascertained and cutoff thresholds were identified. 144 neonates were eligible, and 89 pairs of measurements from 94 patients were analyzed. PCT was a good predictor of infections within POD4, and was a better predictor when compared with CRP at POD1 and POD2. The sum of PCT (pg mL−1) and CRP (mg L−1) > 33 on POD1 or POD2 predicted infections with a 0.68 sensitivity and a 0.82 specificity, and a sum  > 49.36 on POD3 or POD4 predicted infections with a 0.82 sensitivity and a 0.93 specificity. In patients with DHCA, PCT was higher than in those without DHCA, and was not predictive of infections. The accuracy of PCT to identify infections after neonatal cardiac surgery is better than that of CRP when measured within 48 h of surgery. The sum of the two markers measured early after surgery is an excellent predictor of postoperative infections.
Literatur
1.
Zurück zum Zitat Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C (1993) High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 341(8844):515–518PubMedCrossRef Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C (1993) High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 341(8844):515–518PubMedCrossRef
2.
Zurück zum Zitat Auriti C, Fiscarelli E, Ronchetti MP, Argentieri M, Marrocco G, Quondamcarlo A, Seganti G, Bagnoli F, Buonocore G, Serra G et al (2012) Procalcitonin in detecting neonatal nosocomial sepsis. Arch Dis Child Fetal Neonatal Ed 97(5):F368–370PubMedCrossRef Auriti C, Fiscarelli E, Ronchetti MP, Argentieri M, Marrocco G, Quondamcarlo A, Seganti G, Bagnoli F, Buonocore G, Serra G et al (2012) Procalcitonin in detecting neonatal nosocomial sepsis. Arch Dis Child Fetal Neonatal Ed 97(5):F368–370PubMedCrossRef
3.
Zurück zum Zitat Chiesa C, Panero A, Rossi N, Stegagno M, De Giusti M, Osborn JF, Pacifico L (1998) Reliability of procalcitonin concentrations for the diagnosis of sepsis in critically ill neonates. Clin Infect Dis 26(3):664–672PubMedCrossRef Chiesa C, Panero A, Rossi N, Stegagno M, De Giusti M, Osborn JF, Pacifico L (1998) Reliability of procalcitonin concentrations for the diagnosis of sepsis in critically ill neonates. Clin Infect Dis 26(3):664–672PubMedCrossRef
4.
Zurück zum Zitat Neunhoeffer F, Plinke S, Renk H, Hofbeck M, Fuchs J, Kumpf M, Zundel S, Seitz G (2016) Serum concentrations of interleukin-6, procalcitonin, and C-reactive protein: discrimination of septical complications and systemic inflammatory response syndrome after pediatric surgery. Eur J Pediatr Surg 26(2):180–185PubMed Neunhoeffer F, Plinke S, Renk H, Hofbeck M, Fuchs J, Kumpf M, Zundel S, Seitz G (2016) Serum concentrations of interleukin-6, procalcitonin, and C-reactive protein: discrimination of septical complications and systemic inflammatory response syndrome after pediatric surgery. Eur J Pediatr Surg 26(2):180–185PubMed
5.
Zurück zum Zitat Celebi S, Koner O, Menda F, Balci H, Hatemi A, Korkut K, Esen F (2006) Procalcitonin kinetics in pediatric patients with systemic inflammatory response after open heart surgery. Intensive Care Med 32(6):881–887PubMedCrossRef Celebi S, Koner O, Menda F, Balci H, Hatemi A, Korkut K, Esen F (2006) Procalcitonin kinetics in pediatric patients with systemic inflammatory response after open heart surgery. Intensive Care Med 32(6):881–887PubMedCrossRef
6.
Zurück zum Zitat Arkader R, Troster EJ, Lopes MR, Junior RR, Carcillo JA, Leone C, Okay TS (2006) Procalcitonin does discriminate between sepsis and systemic inflammatory response syndrome. Arch Dis Child 91(2):117–120PubMedCrossRef Arkader R, Troster EJ, Lopes MR, Junior RR, Carcillo JA, Leone C, Okay TS (2006) Procalcitonin does discriminate between sepsis and systemic inflammatory response syndrome. Arch Dis Child 91(2):117–120PubMedCrossRef
7.
Zurück zum Zitat Michalik DE, Duncan BW, Mee RB, Worley S, Goldfarb J, Danziger-Isakov LA, Davis SJ, Harrison AM, Appachi E, Sabella C (2006) Quantitative analysis of procalcitonin after pediatric cardiothoracic surgery. Cardiol Young 16(1):48–53PubMedCrossRef Michalik DE, Duncan BW, Mee RB, Worley S, Goldfarb J, Danziger-Isakov LA, Davis SJ, Harrison AM, Appachi E, Sabella C (2006) Quantitative analysis of procalcitonin after pediatric cardiothoracic surgery. Cardiol Young 16(1):48–53PubMedCrossRef
8.
Zurück zum Zitat Rey C, Los Arcos M, Concha A, Medina A, Prieto S, Martinez P, Prieto B (2007) Procalcitonin and C-reactive protein as markers of systemic inflammatory response syndrome severity in critically ill children. Intensive Care Med 33(3):477–484PubMedCrossRef Rey C, Los Arcos M, Concha A, Medina A, Prieto S, Martinez P, Prieto B (2007) Procalcitonin and C-reactive protein as markers of systemic inflammatory response syndrome severity in critically ill children. Intensive Care Med 33(3):477–484PubMedCrossRef
9.
Zurück zum Zitat Simon L, Saint-Louis P, Amre DK, Lacroix J, Gauvin F (2008) Procalcitonin and C-reactive protein as markers of bacterial infection in critically ill children at onset of systemic inflammatory response syndrome. Pediatr Crit Care Med 9(4):407–413PubMedCrossRef Simon L, Saint-Louis P, Amre DK, Lacroix J, Gauvin F (2008) Procalcitonin and C-reactive protein as markers of bacterial infection in critically ill children at onset of systemic inflammatory response syndrome. Pediatr Crit Care Med 9(4):407–413PubMedCrossRef
10.
Zurück zum Zitat Bobillo S, Rodriguez-Fanjul J, Sole A, Moreno J, Balaguer M, Esteban E, Cambra FJ, Jordan I (2018) Kinetics of procalcitonin in pediatric patients on extracorporeal membrane oxygenation. Biomark Insights 13:1177271917751900PubMedPubMedCentralCrossRef Bobillo S, Rodriguez-Fanjul J, Sole A, Moreno J, Balaguer M, Esteban E, Cambra FJ, Jordan I (2018) Kinetics of procalcitonin in pediatric patients on extracorporeal membrane oxygenation. Biomark Insights 13:1177271917751900PubMedPubMedCentralCrossRef
11.
Zurück zum Zitat Chiesa C, Pacifico L, Osborn JF, Bonci E, Hofer N, Resch B (2015) Early-onset neonatal sepsis: still room for improvement in procalcitonin diagnostic accuracy studies. Medicine 94(30):e1230PubMedPubMedCentralCrossRef Chiesa C, Pacifico L, Osborn JF, Bonci E, Hofer N, Resch B (2015) Early-onset neonatal sepsis: still room for improvement in procalcitonin diagnostic accuracy studies. Medicine 94(30):e1230PubMedPubMedCentralCrossRef
12.
Zurück zum Zitat Aouifi A, Piriou V, Bastien O, Blanc P, Bouvier H, Evans R, Celard M, Vandenesch F, Rousson R, Lehot JJ (2000) Usefulness of procalcitonin for diagnosis of infection in cardiac surgical patients. Crit Care Med 28(9):3171–3176PubMedCrossRef Aouifi A, Piriou V, Bastien O, Blanc P, Bouvier H, Evans R, Celard M, Vandenesch F, Rousson R, Lehot JJ (2000) Usefulness of procalcitonin for diagnosis of infection in cardiac surgical patients. Crit Care Med 28(9):3171–3176PubMedCrossRef
13.
Zurück zum Zitat Davidson J, Tong S, Hauck A, Lawson DS, da Cruz E, Kaufman J (2013) Kinetics of procalcitonin and C-reactive protein and the relationship to postoperative infection in young infants undergoing cardiovascular surgery. Pediatr Res 74(4):413–419PubMedPubMedCentralCrossRef Davidson J, Tong S, Hauck A, Lawson DS, da Cruz E, Kaufman J (2013) Kinetics of procalcitonin and C-reactive protein and the relationship to postoperative infection in young infants undergoing cardiovascular surgery. Pediatr Res 74(4):413–419PubMedPubMedCentralCrossRef
14.
Zurück zum Zitat Garcia IJ, Gargallo MB, Torne EE, Lasaosa FJ, Vinas AT, Tolosa CV, Rico AP (2012) Procalcitonin: a useful biomarker to discriminate infection after cardiopulmonary bypass in children. Pediatr Crit Care Med 13(4):441–445PubMedCrossRef Garcia IJ, Gargallo MB, Torne EE, Lasaosa FJ, Vinas AT, Tolosa CV, Rico AP (2012) Procalcitonin: a useful biomarker to discriminate infection after cardiopulmonary bypass in children. Pediatr Crit Care Med 13(4):441–445PubMedCrossRef
15.
Zurück zum Zitat Hammer S, Fuchs AT, Rinker C, Daebritz S, Kozlik-Feldmann R, Netz H (2004) Interleukin-6 and procalcitonin in serum of children undergoing cardiac surgery with cardiopulmonary bypass. Acta Cardiol 59(6):624–629PubMedCrossRef Hammer S, Fuchs AT, Rinker C, Daebritz S, Kozlik-Feldmann R, Netz H (2004) Interleukin-6 and procalcitonin in serum of children undergoing cardiac surgery with cardiopulmonary bypass. Acta Cardiol 59(6):624–629PubMedCrossRef
16.
Zurück zum Zitat Hatherill M, Tibby SM, Sykes K, Turner C, Murdoch IA (1999) Diagnostic markers of infection: comparison of procalcitonin with C reactive protein and leucocyte count. Arch Dis Child 81(5):417–421PubMedPubMedCentralCrossRef Hatherill M, Tibby SM, Sykes K, Turner C, Murdoch IA (1999) Diagnostic markers of infection: comparison of procalcitonin with C reactive protein and leucocyte count. Arch Dis Child 81(5):417–421PubMedPubMedCentralCrossRef
17.
Zurück zum Zitat Rungatscher A, Merlini A, De Rita F, Lucchese G, Barozzi L, Faggian G, Mazzucco A, Luciani GB (2013) Diagnosis of infection in paediatric veno-arterial cardiac extracorporeal membrane oxygenation: role of procalcitonin and C-reactive protein. Eur J Cardio-Thorac Surg 43(5):1043–1049CrossRef Rungatscher A, Merlini A, De Rita F, Lucchese G, Barozzi L, Faggian G, Mazzucco A, Luciani GB (2013) Diagnosis of infection in paediatric veno-arterial cardiac extracorporeal membrane oxygenation: role of procalcitonin and C-reactive protein. Eur J Cardio-Thorac Surg 43(5):1043–1049CrossRef
19.
Zurück zum Zitat Dandona P, Nix D, Wilson MF, Aljada A, Love J, Assicot M, Bohuon C (1994) Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrinol Metab 79(6):1605–1608PubMed Dandona P, Nix D, Wilson MF, Aljada A, Love J, Assicot M, Bohuon C (1994) Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrinol Metab 79(6):1605–1608PubMed
20.
Zurück zum Zitat Sponholz C, Sakr Y, Reinhart K, Brunkhorst F (2006) Diagnostic value and prognostic implications of serum procalcitonin after cardiac surgery: a systematic review of the literature. Crit Care 10(5):R145PubMedPubMedCentralCrossRef Sponholz C, Sakr Y, Reinhart K, Brunkhorst F (2006) Diagnostic value and prognostic implications of serum procalcitonin after cardiac surgery: a systematic review of the literature. Crit Care 10(5):R145PubMedPubMedCentralCrossRef
21.
Zurück zum Zitat Lecharny JB, Khater D, Bronchard R, Philip I, Durand G, Desmonts JM, Dehoux M (2001) Hyperprocalcitonemia in patients with perioperative myocardial infarction after cardiac surgery. Crit Care Med 29(2):323–325PubMedCrossRef Lecharny JB, Khater D, Bronchard R, Philip I, Durand G, Desmonts JM, Dehoux M (2001) Hyperprocalcitonemia in patients with perioperative myocardial infarction after cardiac surgery. Crit Care Med 29(2):323–325PubMedCrossRef
22.
Zurück zum Zitat Picariello C, Lazzeri C, Chiostri M, Gensini G, Valente S (2009) Procalcitonin in patients with acute coronary syndromes and cardiogenic shock submitted to percutaneous coronary intervention. Intern Emerg Med 4(5):403–408PubMedCrossRef Picariello C, Lazzeri C, Chiostri M, Gensini G, Valente S (2009) Procalcitonin in patients with acute coronary syndromes and cardiogenic shock submitted to percutaneous coronary intervention. Intern Emerg Med 4(5):403–408PubMedCrossRef
23.
Zurück zum Zitat Nguyen-Vermillion A, Juul SE, McPherson RJ, Ledbetter DJ (2011) Time course of C-reactive protein and inflammatory mediators after neonatal surgery. J Pediatr 159(1):121–126PubMedCrossRef Nguyen-Vermillion A, Juul SE, McPherson RJ, Ledbetter DJ (2011) Time course of C-reactive protein and inflammatory mediators after neonatal surgery. J Pediatr 159(1):121–126PubMedCrossRef
24.
Zurück zum Zitat Pavcnik-Arnol M, Bonac B, Groselj-Grenc M, Derganc M (2010) Changes in serum procalcitonin, interleukin 6, interleukin 8 and C-reactive protein in neonates after surgery. Eur J Pediatr Surg 20(4):262–266PubMedCrossRef Pavcnik-Arnol M, Bonac B, Groselj-Grenc M, Derganc M (2010) Changes in serum procalcitonin, interleukin 6, interleukin 8 and C-reactive protein in neonates after surgery. Eur J Pediatr Surg 20(4):262–266PubMedCrossRef
25.
Zurück zum Zitat Lapillonne A, Basson E, Monneret G, Bienvenu J, Salle BL (1998) Lack of specificity of procalcitonin for sepsis diagnosis in premature infants. Lancet 351(9110):1211–1212PubMedCrossRef Lapillonne A, Basson E, Monneret G, Bienvenu J, Salle BL (1998) Lack of specificity of procalcitonin for sepsis diagnosis in premature infants. Lancet 351(9110):1211–1212PubMedCrossRef
26.
Zurück zum Zitat Jebali MA, Hausfater P, Abbes Z, Aouni Z, Riou B, Ferjani M (2007) Assessment of the accuracy of procalcitonin to diagnose postoperative infection after cardiac surgery. Anesthesiology 107(2):232–238PubMedCrossRef Jebali MA, Hausfater P, Abbes Z, Aouni Z, Riou B, Ferjani M (2007) Assessment of the accuracy of procalcitonin to diagnose postoperative infection after cardiac surgery. Anesthesiology 107(2):232–238PubMedCrossRef
27.
Zurück zum Zitat Booker PD, Romer H, Franks R (1996) Gut mucosal perfusion in neonates undergoing cardiopulmonary bypass. Br J Anaesth 77(5):597–602PubMedCrossRef Booker PD, Romer H, Franks R (1996) Gut mucosal perfusion in neonates undergoing cardiopulmonary bypass. Br J Anaesth 77(5):597–602PubMedCrossRef
Metadaten
Titel
Procalcitonin Concentration Measured Within the First Days of Cardiac Surgery Is Predictive of Postoperative Infections in Neonates: A Case–Control Study
verfasst von
A. Aryafar
A. Di Marzio
O. Guillard
M. Pontailler
S. Vicca
M. Bojan
Publikationsdatum
16.07.2019
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 6/2019
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-019-02150-y

Weitere Artikel der Ausgabe 6/2019

Pediatric Cardiology 6/2019 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.