Kinetics of procalcitonin and C-reactive protein and the relationship to postoperative infection in young infants undergoing cardiovascular surgery
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Procalcitonin
Cardiothoracic surgery
Cardiothoracic surgery
Vascular surgery
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Objective
To investigate the clinical significance of procalcitonin (PCT) as a non- infectious factor after cardiac surgery.
Methods
Eighty adult patients who underwent selective cardiac operation under direct vision were divided into cardiopulmonary bypass (CPB) group and non-CPB group according to whether CPB was taken or not; the levels of PCT, C-reactive protein (CRP) and white blood cell count (WBC) were measured before and at 0, 12, 36, 60 h after operation, and the time of thoracotomy was recorded. All the data were analyzed.
Results
The levels of PCT and CRP in the two groups at 0, 12, 36 and 60 h after operation were significantly higher than those before operation (P<0.05). The times of peak of PCT and CRP levels in CPB group were earlier than those in non-CPB group. The level of PCT was significantly higher in CPB group than that in non-CBP group at 0 and 12 h after operation (P<0.05). Compared with that before surgery, the values of WBC significantly increased at 12, 36 and 60 h after cardiac surgery (P<0.05). The level of WBC in CPB group was higher than that in non-CPB group at 36 and 60 h after operation (P<0.05). There was a correlation between the time of thoracotomy in cardiac surgery and the levels of PCT at the end of the operation and 12, 36 h after surgery. The correlation coefficients between the different groups were 0.414, 0.489, 0.432 respectiely, and the difference was statistically significant (P<0.05).
Conclusions
PCT is not only a sensitive, specific indicator of systemic infection, but also an inflammatory mediator mediating immune inflammatory response. Cardiac surgery with direct vision and CPB can induce a brief and significant increase in PCT levels, and are associated with trauma time.
Key words:
Cardiac surgery; Procalcitonin; The time of thoracotomy
Procalcitonin
White blood cell
Clinical Significance
Thoracotomy
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Kinetics of activation of newly introduced inflammatory markers is of particular value in their use in postoperative setting after pediatric cardiac surgery.To assess the influence of cardiopulmonary bypass (CPB) on activation of inflammatory markers.Procalcitonin, neopterin and C-reactive protein (CRP) blood levels were measured before, on day 1 and day 2 after surgery in 152 pediatric patients undergoing cardiac surgery with CPB. All patients had infection-free postoperative course.Procalcitonin blood levels increased from 0.08 (0.001-0.19) ng/mL before surgery to 0.79 (0.13-3.5) ng/mL on day 1 (p < 0.001) and 0.52 (0.07-2.7) ng/mL on day 2 (p < 0.001) after surgery. Procalcitonin levels on day 1 correlated with CPB duration, cross-clamping time and use of aprotinin. Neopterin values increased from 8.4 (4.4-32) nmol/L before surgery to 16.1 (6.8-37.6) nmol/L on day 1 (p < 0.001) and 10.9 (5.3-31.1) nmol/L on day 2 (p < 0.001) after surgery. Neopterin levels on day 1 correlated negatively with age, lowest esophageal temperature and use of aprotinin; and positively with circulatory arrest, length of stay and use of modified ultrafiltration. CRP values increased from 4.7 (2.7-9.6) mg/L before surgery to 38.8 (13-73.5) mg/L (p < 0.001) on day 1 and 38.3 (15-88) mg/L (p < 0.001) on day 2 after surgery. CRP levels correlated positively with age at surgery, use of aprotinin and lowest esophageal temperature; and negatively with circulatory arrest and modified ultrafiltration.Procalcitonin and neopterin levels peaked on day 1, CRP levels remained elevated during first two postoperative days. Neopterin and CRP had age dependent kinetics (Tab. 2, Fig. 2, Ref. 18). Full Text (Free, PDF) www.bmj.sk.
Procalcitonin
Neopterin
Aprotinin
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Cardiothoracic surgery
Vascular surgery
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Cardiothoracic surgery
Hydatid cyst
Vascular surgery
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UNLABELLED Cardiac surgery induces systemic inflammatory response that may have been implicated the postoperative organ dysfunction. This inflammatory response is thought to be produced by exposing patients to proinflammatory factors. The aim of our study was to investigate alterations in procalcitonin (PCT) concentration in peripheral blood in children as the potential early indicator of complications occurring during and after surgery in extracorporeal circulation. Additionally, we evaluated the perioperative time course of IL-6. MATERIAL AND METHODS The investigations were carried out in 21 children undergoing cardiac operation with cardiopulmonary bypass (CPB). Serum concentrations of PCT and IL-6 were sequentially measured before induction of anesthesia, at the initiation of CPB, at the end of CPB, and 24 hours, and 72 hours after CPB. RESULTS There was no significant PCT-elevation at all 5 times of measurement. Levels of IL-6 increased significantly after surgery, and remained elevated for up to 1 day. Peak values correlated with the duration of CPB (r=0.68, p=0.0006). CONCLUSIONS We conclude, that cardiac surgery with CPB did not have any influence on the secretion of PCT in children. These results suggest that IL-6 was more effective than PCT to monitor patients with a favorable outcome.
Procalcitonin
Extracorporeal circulation
Extracorporeal
Proinflammatory cytokine
Inflammatory response
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Cardiothoracic surgery
Stroke
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Background Diagnosing infection in infants after cardiac surgery with cardiopulmonary bypass remains challenging. We aimed to determine whether procalcitonin discriminates post-cardiopulmonary bypass systemic inflammatory response syndrome from bacterial infection in infants better than C-reactive protein and leukocyte count. Method One hundred and eight infants underwent cardiac surgery with cardiopulmonary bypass. Leukocyte count, C-reactive protein, and procalcitonin were measured on arrival in the intensive care unit as baseline, and repeated on postoperative day 3. Bacterial infection was defined as proven infection with a positive blood or sputum culture. Results Twenty-four infants had proven bacterial infection. Baseline leukocyte counts and C-reactive protein levels did not differ significantly between the 2 groups. On postoperative day 3, C-reactive protein (62 vs. 38.5 mg·L −1 , p = 0.01) and procalcitonin levels (6.58 vs. 0.41 ng·mL −1 , p < 0.01) were higher in patients with bacterial infection. Leukocyte counts did not differ significantly between the two groups ( p = 0.94). The area under the receiver operating curve for leukocyte count, C-reactive protein, and procalcitonin was 0.49 ( p = 0.94), 0.67 ( p = 0.01), and 0.87 ( p < 0.0010), respectively. The optimal cutoff value of procalcitonin was 2.5 ng·mL −1 (sensitivity 75%, specificity 88%). Conclusion In infants undergoing cardiac surgery with cardiopulmonary bypass, procalcitonin discriminates bacterial infection from post-cardiopulmonary bypass systemic inflammatory response syndrome better than C-reactive protein and leukocyte count.
Procalcitonin
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Vascular surgery
Cardiothoracic surgery
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