Procalcitonin in the Early Course Post Pediatric Cardiac Surgery

Robert Zant, MD; Christian Stocker, MD, FMH (CH), FCICM; Luregn Jan Schlapbach, MD, FCICM; Sara Mayfield, BHScNurs; Tom Karl, MD, FRACS; Andreas Schibler, MD, FMH (CH), FCICM

Disclosures

Pediatr Crit Care Med. 2016;17(7):624-629. 

In This Article

Abstract and Introduction

Abstract

Objective: Procalcitonin has emerged as a promising infection marker, but previous reports from small-sized studies suggest nonspecific elevation of procalcitonin after pediatric heart surgery. As procalcitonin is increasingly used as a marker for infection in the PICU, the aim of this study was to identify factors associated with postoperative procalcitonin elevation and to investigate the role of procalcitonin as an early marker of outcome after cardiac surgery.

Design: Prospective observational study.

Setting: Single, tertiary referral PICU.

Patients: Patients aged 0–16 years following cardiac surgery with or without cardiopulmonary bypass.

Interventions: Procalcitonin was measured in all patients at admission to PICU, and on postoperative day 1 and 2. Outcome variables included major adverse event, length of stay in PICU, postoperative renal failure requiring temporary dialysis, duration of mechanical ventilation and duration of inotropic support. A major adverse event was defined as cardiac arrest, need for postoperative extracorporeal life support or death within 3 months of cardiac surgery.

Measurements and Main Results: In 221 included patients who underwent 232 operations, procalcitonin at admission to PICU was significantly associated with mechanical ventilation prior to surgery (p = 0.001), preoperative myocardial dysfunction (p = 0.002), duration of cardiopulmonary bypass (p < 0.001), intraoperative cross-clamp time (p = 0.015), and serum lactate at admission (p < 0.001). Patients suffering a major adverse event and patients with postoperative renal failure had significantly higher procalcitonin levels at admission to PICU (p = 0.04 and 0.01, respectively). Furthermore, procalcitonin levels at admission correlated significantly with the length of stay in the PICU (p = 0.005), time on mechanical ventilation (p = 0.03), and duration of inotropic support (p = 0.02).

Conclusions: Elevated levels of procalcitonin in the early phase after pediatric cardiac surgery are a marker for increased risk for major adverse events and postoperative renal failure and increased postoperative morbidity.

Introduction

The immediate postoperative phase after cardiac surgery is affected by bypass-induced systemic inflammatory response syndrome (SIRS), which is difficult to differentiate from with microorganism-induced SIRS. Procalcitonin, has emerged recently as a marker of infection in PICU. As with many other inflammatory markers, procalcitonin has been shown to be non specifically elevated in the absence of infection after uncomplicated pediatric open heart surgery,[1] reaching a maximum level within 24 hours postoperatively.[2] In adults, high procalcitonin levels after cardiac surgery have been shown to correlate with several severity of illness scoring systems, including the acute physiology and chronic health evaluation II and the simplified acute physiology score. Nonsurvivors were more likely to have high levels.[3–6] There is a limited number of publications based on small sample size describing the postoperative changes of procalcitonin in children after cardiac surgery.[1,7]

In view of the increasing use of procalcitonin as a sepsis marker in children, including postoperative patients, better knowledge on the course of procalcitonin post cardiac surgery is required. The aim of this study was to investigate the factors associated with high procalcitonin levels and to investigate the role of procalcitonin as a prognostic marker for outcome after surgery in a large cohort of infants and children undergoing surgery for congenital heart disease.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....