Kinetics of procalcitonin and C-reactive protein and the relationship to postoperative infection in young infants undergoing cardiovascular surgery

Journal name:
Pediatric Research
(2013)
Volume:
74,
Pages:
413–419
DOI:
doi:10.1038/pr.2013.124
Received
Accepted
Accepted article preview online
Advance online publication

Abstract

Background:

The utility of procalcitonin (PCT) and C-reactive protein (CRP) as infectious biomarkers following infant cardiothoracic surgery is not well defined.

Methods:

We designed a prospective cohort study to evaluate PCT and CRP after infant cardiothoracic surgery. PCT and CRP were drawn preoperatively and 24/72h postoperation or daily in delayed sternal closure patients. Presence of infection within 10 d of surgery, vasoactive-inotropic scores at 24 and 72h, and length of intubation, intensive care unit stay, and hospital stay were documented.

Results:

PCT and CRP were elevated at 24h. PCT then decreased while CRP increased in patients undergoing delayed sternal closure or cardiopulmonary bypass. In the delayed sternal closure group, PCT was significantly higher on postoperative days 2–5 in patients who ultimately developed infection. Higher PCT was independently associated with increased vasoactive-inotropic score at 72h. CRP did not correlate with infection or postoperative support.

Conclusion:

PCT rises after cardiothoracic surgery in infants but decreases by 72h while CRP remains elevated. Sternal closure may affect CRP but not PCT. PCT is independently associated with circulatory support requirements at 72h postoperation and with development of infection. PCT may have greater utility as a biomarker in this population.

At a glance

Figures

  1. Figure 1:

    Recruitment flowchart.

  2. Figure 2:

    Daily levels of (a) procalcitonin (PCT) and (b) C-reactive protein (CRP) in patients undergoing delayed sternal closure (DSC). Box = 25–75%; line inside box = median; cross = mean; small box = outlier.

  3. Figure 3:

    Trends in (a) mean procalcitonin (PCT) and (b) mean C-reactive protein (CRP) levels in infected vs. noninfected patients. Solid line = infection; dashes = no infection; bars = SE.

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Affiliations

  1. Department of Pediatrics, Children’s Hospital Colorado, Aurora, Colorado

    • Jesse Davidson,
    • Amanda Hauck,
    • D. Scott Lawson,
    • Eduardo da Cruz &
    • Jon Kaufman
  2. Department of Biostatistics, University of Colorado Denver, Aurora, Colorado

    • Suhong Tong

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