Hostname: page-component-76fb5796d-skm99 Total loading time: 0 Render date: 2024-04-29T08:04:50.463Z Has data issue: false hasContentIssue false
  • English
  • Français

Quantitative analysis of procalcitonin after pediatric cardiothoracic surgery

Published online by Cambridge University Press:  03 February 2006

David E. Michalik ,
Brian W. Duncan ,
Roger B. B. Mee ,
Sarah Worley ,
Johanna Goldfarb ,
Lara A. Danziger-Isakov ,
Stephen J. Davis ,
A. Marc Harrison ,
Elumalai Appachi  and
Camille Sabella
David E. Michalik
Affiliation:
Division of Pediatrics, The Children's Hospital, The Cleveland Clinic, Cleveland, Ohio, United States of America
Brian W. Duncan
Affiliation:
Department of Pediatric and Congenital Heart Surgery, Division of Pediatrics, The Children's Hospital, The Cleveland Clinic, Cleveland, Ohio, United States of America
Roger B. B. Mee
Affiliation:
Department of Pediatric and Congenital Heart Surgery, Division of Pediatrics, The Children's Hospital, The Cleveland Clinic, Cleveland, Ohio, United States of America
Sarah Worley
Affiliation:
Division of Pediatrics, The Children's Hospital, The Cleveland Clinic, Cleveland, Ohio, United States of America
Johanna Goldfarb
Affiliation:
Section of Pediatric Infectious Diseases, Division of Pediatrics, The Children's Hospital, The Cleveland Clinic, Cleveland, Ohio, United States of America
Lara A. Danziger-Isakov
Affiliation:
Section of Pediatric Infectious Diseases, Division of Pediatrics, The Children's Hospital, The Cleveland Clinic, Cleveland, Ohio, United States of America
Stephen J. Davis
Affiliation:
Department of Pediatric Critical Care, Division of Pediatrics, The Children's Hospital, The Cleveland Clinic, Cleveland, Ohio, United States of America
A. Marc Harrison
Affiliation:
Department of Pediatric Critical Care, Division of Pediatrics, The Children's Hospital, The Cleveland Clinic, Cleveland, Ohio, United States of America
Elumalai Appachi
Affiliation:
Department of Pediatric Critical Care, Division of Pediatrics, The Children's Hospital, The Cleveland Clinic, Cleveland, Ohio, United States of America
Camille Sabella
Affiliation:
Section of Pediatric Infectious Diseases, Division of Pediatrics, The Children's Hospital, The Cleveland Clinic, Cleveland, Ohio, United States of America
Get access Rights & Permissions [Opens in a new window]

Abstract

Procalcitonin appears to be an early and sensitive marker of bacterial infection in a variety of clinical settings. The use of levels of procalcitonin to predict infection in children undergoing cardiac surgery, however, may be complicated by the systemic inflammatory response that normally accompanies cardiopulmonary bypass. The aim of our study was to estimate peri-operative concentrations of procalcitonin in non-infected children undergoing cardiac surgery. Samples of serum for assay of procalcitonin were obtained in 53 patients at baseline, 24, 48, and 72 hours following cardiac surgery. Concentrations were assessed using an immunoluminetric technique. Median concentrations were lowest at baseline at less than 0.5 nanograms per millilitre, increased at 24 hours to 1.8 nanograms per millilitre, maximized at 48 hours at 2.1 nanograms per millilitre, and decreased at 72 hours to 1.3 nanograms per millilitre, but did not return to baseline levels. Ratios of concentrations between 24, 48 and 72 hours after surgery as compared to baseline were 6.15, with 95 percent confidence intervals between 4.60 and 8.23, 6.49, with 95 percent confidence intervals from 4.55 to 9.27, and 4.26, with 95 percent confidence intervals between 2.78 and 6.51, respectively, with a p value less than 0.001. In 8 patients, who had no evidence of infection, concentrations during the period from 24 to 72 hours were well above the median for the group. We conclude that concentrations of procalcitonin in the serum increase significantly in children following cardiac surgery, with a peak at 48 hours, and do not return to baseline within 72 hours of surgery. A proportion of patients, in the absence of infection, had exaggerated elevations post-operatively.

Keywords

Cardiopulmonary bypasssystemic inflammatory responsecongenital heart diseaseinfection
Type
Original Article
Information
Cardiology in the Young , Volume 16 , Issue 1 , January 2006 , pp. 48 - 53
Copyright
© 2006 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.)

References

Levy I, Ovadia B, Erez E, et al. Nosocomial infections after cardiac surgery in infants and children: incidence and risk factors. J Hosp Infect 2003; 53: 111–116.Google Scholar
Al-Nawas B, Krammer I, Shah PM. Procalcitonin in the diagnosis of severe infections. Eur J Med Res 1996; 1: 331–333.Google Scholar
Dandona P, Nix D, Wilson MF. Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrinol Metab 1994; 79: 1605–1608.Google Scholar
Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohoun C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 1993; 3: 515–518.Google Scholar
Gendrel D, Raymond J, Coste J, et al. Comparison of procalcitonin with C-reactive protein, interleukin 6 and interferon-alpha for differentiation of bacterial vs. vial infections. Pediatr Inf Dis J 1999; 18: 875–881.Google Scholar
Lacour AG, Gervaix A, Zamora SA, et al. Procalcitonin, IL-6, IL-1 receptor antagonist and C-reactive protein as identificators of serious bacterial infections in children with fever without localizing signs. Eur J Pediatr 2001; 160: 95–100.Google Scholar
Enguix A, Rey C, Concha A, Medina A, Coto D, Dieguez MA. Comparison of procalcitonin with C-reactive protein and serum amyloid for the early diagnosis of bacterial sepsis in critically ill neonates and children. Intensive Care Med 2001; 27: 211–215.Google Scholar
Hatherill M, Tibby S, Sykes K, Turner C, Murdoch I. Diagnostic markers of infection: comparison of procalcitonin with C-reactive protein and leukocyte count. Arch Dis Child 1999; 81: 417–421.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
Luzzani A, Polati E, Dorizzi R, Rungatscher A, Pavan R, Merlini A. Comparison of procalcitonin and C-reactive protein as markers of sepsis. Crit Care Med 2003; 31: 1737–1741.Google Scholar
Meisner M, Tschaikowsky K, Hutzler A, Schick C, Schuettler J. Postoperative plasma concentrations of procalcitonin after different types of surgery. Intensive Care Med 1998; 680–684.Google Scholar
Mimoz O, Benoist JF, Edouward 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
Boeken U, Feindt P, Micek M, Petzold T, Schulte HD, Gams E. Procalcitonin in cardiac surgery: diagnostic value in systemic inflammatory response syndrome, sepsis and after heart transplantation. Cardiovasc Surg 2000; 8: 550–554.Google Scholar
DeWerra I, Jaccard C, Betz Corradin S. Cytokines, NO3/NO2, soluble TNF receptors and procalcitonin levels: comparisons in patients with septic shock, cardiogenic shock, and bacterial pneumonia. Crit Care Med 1997; 25: 607–613.Google Scholar
Taylor KM. SIRS – The systemic inflammatory response syndrome after cardiac operations. Ann Thorac Surg 1996; 61: 1607–1608.Google Scholar
Hensel M, Volk T, Doeke WD, et al. Hyperprocalcitoninemia in patients with noninfectious SIRS and pulmonary dysfunction associated with cardiopulmonary bypass. Anethesiology 1998; 89: 93–104.Google Scholar
Doerge H, Schoendube FA, Doerge P, Seipelt, Voss M, Messmer BJ. Procalcitonin is a valuable prognostic marker in cardiac surgery but not specific for infection. Thorac Cardiov Surg 2003; 51: 322–326.Google Scholar
Monneret G, Labaune JM, Isaac C, Bienvenu F, Putet G, Bienvenu J. Procalcitonin and C-reactive protein levels in neonatal infections. Acta Paediatr 1997; 86: 209–212.Google Scholar
Chiesa C, Panero A, Rossi N, et al. Reliability of procalcitonin concentrations for the diagnosis of sepsis in critically ill neonates. Clin Infect Dis 1998; 26: 664–672.Google Scholar
Casado-Flores J, Blanco-Quiros A, Asensio J, Arranz E, Garrote JA, Nieto M. Serum procalcitonin in children with suspected sepsis: A comparison with C-reactive protein and neutrophil count. Pediatr Crit Care Med 2003; 4: 190–195.Google Scholar
Gervaix A, Galetto-Lacour A, Gueron T, et al. Usefulness of procalcitonin and C-reactive protein rapid tests for the management of children with urinary tract infection. Pediatr Infect Dis J 2001; 20: 507–511.Google Scholar
Moulin F, Raymond J, Lorrot M, et al. Procalcitonin in children admitted to the hospital with community acquired pneumonia. Arch Dis Child 2001; 84: 332–336.Google Scholar
Gendrel D, Raymond J, Assicot M, et al. Measurement of procalcitonin levels in children with bacterial or viral meningitis. Clin Infect Dis 1997; 24: 1240–1242.Google Scholar
Lecharny J-B, Khater D, Bronchard R, Philip I, Durand G, Desmonts J-M, Dehoux M. Hyperprocalcitoninemia in patients with perioperative myocardial infarction after cardiac surgery. Crit Care Med 2001; 29: 323–325.Google Scholar
Selberg O, Hecker H, Martin M, Klos A, Bautsch W, Koehl J. Discrimination of sepsis and systemic inflammatory response syndrome by determination of circulating plasma concentrations of procalcitonin, protein complement 3a, and interleukin 6. Crit Care Med 2000; 28: 2793–2798.Google Scholar
Meisner M, Tschaikowsky K, Hutzler A, Harig F, von der Emde J. Postoperative plasma concentrations of procalcitonin and C-reactive protein in patients undergoing cardiac and thoracic surgery with and without cardiopulmonary bypass. Cardiovasc Engineering 1998; 3: 174–178.Google Scholar
Kilger E, Pichler B, Goetz AE, et al. Procalcitonin as a marker of systemic inflammation after conventional or minimally invasive coronary artery bypass grafting. Thorac Cardiovasc Surg 1998; 48: 130–133.Google Scholar
Aouifi A, Piriou V, Bastien O, et al. Usefulness of procalcitonin for diagnosis of infection in cardiac surgical patients. Crit Care Med 2000; 28: 3171–3176.Google Scholar
Beghetti M, Rimensberger PC, Kalangos A, Habre W, Gervaix A. Kinetics of procalcitonin, interleukin-6 and C-reactive protein after cardiopulmonary bypass in children. Cardiol Young 2003; 13: 161–167.Google Scholar