Procalcitonin as a biomarker of bacterial infection in pediatric patients after congenital heart surgery

Abstract Objectives: Differentiation between post-operative inflammation and bacterial infection remains an important issue in infants following congenital heart surgery. We primarily assessed kinetics and predictive value of C-reactive protein for bacterial infection in the early (days 0–4) and late (days 5–28) period after cardiopulmonary bypass surgery. Secondary objectives were frequency, type, and timing of post-operative infection related to the risk adjustment for congenital heart surgery score. Methods: This 3-year single-centre retrospective cohort study in a paediatric cardiac ICU analysed 191 infants accounting for 235 episodes of CPBP surgery. Primary outcome was kinetics of CRP in the first 28 days after CPBP surgery in infected and non-infected patients. Results: We observed 22 infectious episodes in the early and 34 in the late post-operative period. CRP kinetics in the early post-operative period did not accurately differentiate between infected and non-infected patients. In the late post-operative period, infected infants displayed significantly higher CRP values with a median of 7.91 (1.64–22.02) and 6.92 mg/dl (1.92–19.65) on days 2 and 3 compared to 4.02 (1.99–15.9) and 3.72 mg/dl (1.08–9.72) in the non-infection group. Combining CRP on days 2 and 3 after suspicion of infection revealed a cut-off of 9.47 mg/L with an acceptable predictive accuracy of 76%. Conclusions: In neonates and infants, CRP kinetics is not useful to predict infection in the first 72 hours after CPBP surgery due to the inflammatory response. However, in the late post-operative period, CRP is a valuable adjunctive diagnostic test in conjunction with clinical presentation and microbiological diagnostics.

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Compromised Ventilation Caused by Transesophageal Echocardiography Probe in Pediatric Patients Undergoing Congenital Heart Surgery - A case report -

Korean Journal of Anesthesiology ◽

10.4097/kjae.2008.54.6.682 ◽

2008 ◽

Vol 54 (6) ◽

pp. 682 ◽

Cited By ~ 2

Author(s):

Sung Yong Park ◽

Sun Kyung A Park ◽

You Sun Hong ◽

Yong Woo Hong

Keyword(s):

Case Report ◽

Transesophageal Echocardiography ◽

Congenital Heart ◽

Heart Surgery ◽

Pediatric Patients ◽

Congenital Heart Surgery

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The Association Between Cardiac Biomarker NT-proBNP and 30-Day Readmission or Mortality After Pediatric Congenital Heart Surgery

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135119842864 ◽

2019 ◽

Vol 10 (4) ◽

pp. 446-453 ◽

Cited By ~ 4

Author(s):

Devin M. Parker ◽

Allen D. Everett ◽

Meagan E. Stabler ◽

JoAnna Leyenaar ◽

Luca Vricella ◽

...

Keyword(s):

Congenital Heart ◽

Heart Surgery ◽

Pediatric Patients ◽

Risk Model ◽

Pediatric Population ◽

Kidney Injury ◽

Congenital Heart Surgery ◽

Cardiac Biomarker ◽

Increased Risk ◽

Heart Operation

Background: Very little is known about clinical and biomarker predictors of readmissions following pediatric congenital heart surgery. The cardiac biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) can help predict readmission in adult populations, but the estimated utility in predicting risk of readmission or mortality after pediatric congenital heart surgery has not previously been studied. Our objective was to evaluate the association between pre- and postoperative serum biomarker levels and 30-day readmission or mortality for pediatric patients undergoing congenital heart surgery. Methods: We measured pre- and postoperative NT-proBNP levels in two prospective cohorts of 522 pediatric patients <18 years of age who underwent at least one congenital heart operation from 2010 to 2014. Blood samples were collected before and after surgery. We evaluated the association between pre- and postoperative NT-proBNP with readmission or mortality within 30 days of discharge, using multivariate logistic regression, adjusting for covariates based on the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Mortality Risk Model. Results: The Johns Hopkins Children's Center cohort and the Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury (TRIBE-AKI) cohort demonstrate event rates of 12.9% and 9.4%, respectively, for the composite end point. After adjustment for covariates in the STS congenital risk model, we did not find an association between elevated levels of NT-proBNP and increased risk of readmission or mortality following congenital heart surgery for either cohort. Conclusions: In our two cohorts, preoperative and postoperative values of NT-proBNP were not significantly associated with readmission or mortality following pediatric congenital heart surgery. These findings will inform future studies evaluating multimarker risk assessment models in the pediatric population.

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