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

Aryafar, A; Marzio, Alessandra Di; Guillard, Olivier; Pontailler, Margaux; Vicca, Stéphanie; Bojan, Mirela

doi:10.1007/s00246-019-02150-y

Cited by 8 publications

(14 citation statements)

References 27 publications

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“…Although the studies mentioned above support the monitoring of PCT rather than CRP, the meta‐analysis performed by Ruan et al concluded that the combination of both resulted in higher sensitivity and area under the curve and lower negative likelihood ratio, which helped in confirming and ruling out neonatal sepsis 42 . Also, Aryafar et al 16 suggested thata combination of both biomarkers could be the best predictor of infections within 4 days of surgery.…”

Section: Discussionmentioning

confidence: 99%

C‐reactive protein and procalcitonin after congenital heart surgery utilizing cardiopulmonary bypass: When should we be worried?

Farias

Villarreal

Dhargalkar

et al. 2021

Journal of Cardiac Surgery

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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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Section: Discussionmentioning

confidence: 99%

C‐reactive protein and procalcitonin after congenital heart surgery utilizing cardiopulmonary bypass: When should we be worried?

Farias

Villarreal

Dhargalkar

et al. 2021

Journal of Cardiac Surgery

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“…The findings were similar to study by Nasser et al who demonstrated that these inflammatory markers can not differentiate between inflammation and infection. [21], though role of procalcitonin in identifying infections after cardiac surgery is increasingly being recognised [22].…”

Section: Discussionmentioning

confidence: 99%

Common inflammatory markers after cardiac surgery in infants and their relation to blood stream sepsis

Abqari

Kappanayil

Sudhakar

et al. 2019

Heliyon

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BackgroundLimited information exists on trends of common inflammatory markers after infant heart surgery and their role in identifying post-operative sepsis.Methods275 consecutive infants undergoing cardiac surgery (231 with and 44 without Cardiopulmonary Bypass) were studied prospectively. Daily trends (0–4 day post-operative) of leucocyte counts, platelet counts and C-reactive protein were recorded. Association of these trends with early post-operative bloodstream sepsis, Cardiopulmonary Bypass and surgical outcomes were studied.ObservationsTrends of these inflammatory markers were noted. While off-Cardiopulmonary Bypass Surgery, and sepsis were associated with a statisticaly insignificant rise in total leucocyte count peaking on first post-operative day, Cardiopulmonary Bypass exposure was associated with significant decline (p = 0.002), more pronounced with Cardiopulmonary Bypass-exposure exceeding 150 min. Percentage of neutrophils showed a rise (maximum on first post-operative day) but no significant association with sepsis or Cardiopulmonary Bypass.Platelet counts significantly declined after surgery, with nadir on 2nd POD (p < 0.001), the drop being more marked in patients operated on Cardiopulmonary Bypass (p < 0.005). Counts were significantly lower in patients exposed to >150 min Cardiopulmonary Bypass compared to those with shorter Cardiopulmonary Bypass. Septic patients had significantly lower platelet counts than uninfected patients, decline >2 SD from mean pre-operative level strongly associated with sepsis (p < 0.001).C-Reactive Protein levels rose markedly after surgery, peaking on 2nd POD; levels were significantly higher if operated on Cardiopulmonary Bypass. Cardiopulmonary Bypass >150 min was associated with lower mean C-Reactive Protein on first post-operative day, but significantly higher values on third and fourth post-operative days, as compared to Cardiopulmonary Bypass <150 min. Comparison of infected versus non-infected patients showed significantly higher mean C-Reactive Protein in the former group.ConclusionWhile leucocyte count, platelet count and C-Reactive Protein emerged as useful markers of post-operative inflammatory response and reaction to Cardiopulmonary Bypass, they proved unsatisfactory predictors of early post-operative sepsis.

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“…The paediatric literature on the kinetics of PCT and CRP in the post-operative period is primarily focused on the postneonatal age group or patients undergoing cardiac surgery. [3][4][5][6][7][8][9][10][11] There are scarce data on PCT or CRP among neonates undergoing non-cardiac surgery. Celik et al showed that CRP concentrations on post-operative days (PODs) 2, 4 and 6 were significantly higher than baseline after neonatal abdominal surgery.…”

Section: What This Paper Addsmentioning

confidence: 99%

Procalcitonin and C‐reactive protein for diagnosing post‐operative sepsis in neonates

Rao

Dutta

Menon

et al. 2021

J Paediatrics Child Health

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Aim: To determine whether serum procalcitonin (PCT) or C-reactive protein (CRP) can diagnose post-operative sepsis among neonates undergoing major non-cardiac surgery. Methods: In this diagnostic study, we included neonates who underwent major non-cardiac surgery and were monitored for post-operative sepsis. We excluded pre-existing septic, inflammatory or life-threatening conditions. Subjects either had 'definite' (culture-positive, n = 14), 'probable' (clinical sepsis, culture-negative, n = 25) or no sepsis (n = 31). We measured serum CRP and PCT at 48 AE 6 h, 72 AE 6 h and 96 AE 6 h postoperatively and compared 'definite or probable sepsis' with 'no sepsis'. Results: Median (Q1, Q3) CRP (mg/L) in 'definite or probable' sepsis group was higher than 'no sepsis' at 72 h (91.48 (57.87, 143.50) vs. 51.32 (33.0, 80.1); P = 0.009) and 96 h (87.51 (45.19, 128.22) vs. 31.00 (25.3, 45.2); P < 0.001). Median (Q1, Q3) PCT (ng/mL) in 'definite or probable' sepsis was higher than 'no sepsis' at 72 h (4.22 (2.04, 12.73) vs. 1.78 (0.9, 6.4); P = 0.01) and 96 h (3.54 (1.96, 9.65) vs. 0.97 (0.4, 3.0); P < 0.001). Ninety-six-hour CRP and PCT cut-offs (based on Youden's index) were 74.16 mg/L and 1.65 ng/mL, respectively. If both CRP and PCT were positive, specificity was 100% (95% confidence interval: 88.78-100). If either one was positive, sensitivity was 88.89% (95% confidence interval: 73.94-96.89). Conclusions: Septic neonates have significantly higher serum CRP and PCT compared to non-septic neonates at 72 and 96 h post-operatively. If both CRP and PCT are positive at 96 h after surgery, it has 100% specificity, and if either one is positive, 89% sensitivity.

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

Cited by 8 publications

References 27 publications

C‐reactive protein and procalcitonin after congenital heart surgery utilizing cardiopulmonary bypass: When should we be worried?

C‐reactive protein and procalcitonin after congenital heart surgery utilizing cardiopulmonary bypass: When should we be worried?

Common inflammatory markers after cardiac surgery in infants and their relation to blood stream sepsis

Procalcitonin and C‐reactive protein for diagnosing post‐operative sepsis in neonates

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