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Procalcitonin as a marker of bacterial infection in children undergoing cardiac surgery with cardiopulmonary bypass

Published online by Cambridge University Press:  09 March 2011

Pierre-Emmanuel Séguéla ,
Nicolas Joram ,
Bénédicte Romefort ,
Céline Manteau ,
Jean-Luc Orsonneau ,
Bernard Branger ,
Véronique Gournay ,
Jean-Christophe Rozé  and
Christèle Gras-Le Guen
Pierre-Emmanuel Séguéla*
Affiliation:
Pediatric Cardiology Unit, Nantes University Hospital, Nantes, France
Nicolas Joram
Affiliation:
Pediatric Intensive Care Unit, Nantes University Hospital, Nantes, France
Bénédicte Romefort
Affiliation:
Pediatric Intensive Care Unit, Nantes University Hospital, Nantes, France
Céline Manteau
Affiliation:
Pediatric Department, Nantes University Hospital, Nantes, France
Jean-Luc Orsonneau
Affiliation:
Biochemistry Laboratory, Nantes University Hospital, Nantes, France
Bernard Branger
Affiliation:
Réseau Sécurité Naissance Naître Ensemble des Pays de la Loire, Nantes University Hospital, Nantes, France
Véronique Gournay
Affiliation:
Pediatric Cardiology Unit, Nantes University Hospital, Nantes, France
Jean-Christophe Rozé
Affiliation:
Pediatric Intensive Care Unit, Nantes University Hospital, Nantes, France
Christèle Gras-Le Guen
Affiliation:
Pediatric Intensive Care Unit, Nantes University Hospital, Nantes, France
*
Correspondence to: Dr P.-E. Séguéla, Pediatric Cardiology Unit, Children's Hospital, Toulouse University Hospital, 330 Avenue de Grande-Bretagne, 31059 Toulouse Cedex 9, France. Tel: 0033 534557459; Fax: 003 534558663; E-mail: peseguela@yahoo.fr
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Abstract

Background

Owing to systemic inflammatory response syndrome, the diagnosis of post-operative infection after cardiopulmonary bypass is difficult to assess in children with the usual clinical and biological tools. Procalcitonin could be informative in this context.

Methods

Retrospective study in a paediatric intensive care unit. Blood samples were collected as soon as infection was clinically suspected and a second assay was performed 24 hours later. Using referenced criteria, children were retrospectively classified into two groups: infected and non-infected.

Results

Out of the 95 children included, 14 were infected. Before the third post-operative day, procalcitonin median concentration was significantly higher in the infected group than in the non-infected group – 20.24 nanograms per millilitre with a 25th and 75th interquartile of 15.52–35.71 versus 0.72 nanograms per millilitre with a 25th and 75th interquartile of 0.28 to 5.44 (p = 0.008). The area under the receiver operating characteristic curve was 0.89 with 95% confidence intervals from 0.80 to 0.97. The best cut-off value to differentiate infected children from healthy children was 13 nanograms per millilitre with 100% sensitivity – 95% confidence intervals from 51 to 100 – and 85% specificity – 95% confidence intervals from 72 to 91. After the third post-operative day, procalcitonin was not significantly higher in infected children – 2 nanograms per millilitre with a 25th and 75th interquartile of 0.18 to 12.42 versus 0.37 nanograms per millilitre with a 25th and 75th interquartile of 0.24 to 1.32 (p = 0.26). The area under the receiver operating characteristic curve was 0.62 with 95% confidence intervals from 0.47 to 0.77. A procalcitonin value of 0.38 nanograms per millilitre provided a sensitivity of 70% with 95% confidence intervals from 39 to 89 for a specificity of 52% with 95% confidence intervals from 34 to 68. After the third post-operative day, a second assay at a 24-hour interval can improve the sensitivity of the test.

Conclusions

Procalcitonin seems to be a discriminating marker of bacterial infection during the post-operative days following cardiopulmonary bypass in children.

Keywords

Systemic inflammatory response syndromecardiac surgerybiological marker
Type
Original Articles
Information
Cardiology in the Young , Volume 21 , Issue 4 , 12 July 2011 , pp. 392 - 399
Copyright
Copyright © Cambridge University Press 2011

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