calca-protein--human and Heart-Defects--Congenital

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

Topics: Age Distribution; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Child, Preschool; Cohort Studies; Cross Infection; Female; Follow-Up Studies; Heart Defects, Congenital; Hospital Mortality; Humans; Incidence; Infant; Intensive Care Units, Pediatric; Male; Postoperative Complications; Predictive Value of Tests; Protein Precursors; Retrospective Studies; Risk Assessment; Sensitivity and Specificity; Statistics, Nonparametric; Survival Rate; Systemic Inflammatory Response Syndrome; Treatment Outcome

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.

Topics: Adolescent; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Child; Child, Preschool; Glycoproteins; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Neopterin; Protein Precursors

To evaluate whether procalcitonin (PCT) and C reactive protein (CRP) are able to discriminate between sepsis and systemic inflammatory response syndrome (SIRS) in critically ill children.. Prospective, observational study in a paediatric intensive care unit. Kinetics of PCT and CRP were studied in patients undergoing open heart surgery with cardiopulmonary bypass (CPB) (SIRS model; group I1) and patients with confirmed bacterial sepsis (group II).. In group I, PCT median concentration was 0.24 ng/ml (reference value <2.0 ng/ml). There was an increment of PCT concentrations which peaked immediately after CPB (median 0.58 ng/ml), then decreased to 0.47 ng/ml at 24 h; 0.33 ng/ml at 48 h, and 0.22 ng/ml at 72 h. CRP median concentrations remained high on POD1 (36.6 mg/l) and POD2 (13.0 mg/l). In group II, PCT concentrations were high at admission (median 9.15 ng/ml) and subsequently decreased in 11/14 patients who progressed favourably (median 0.31 ng/ml). CRP levels were high in only 11/14 patients at admission. CRP remained high in 13/14 patients at 24 h; in 12/14 at 48 h; and in 10/14 patients at 72 h. Median values were 95.0, 50.9, 86.0, and 20.3 mg/l, respectively. The area under the ROC curve was 0.99 for PCT and 0.54 for CRP. Cut off concentrations to differentiate SIRS from sepsis were >2 ng/ml for PCT and >79 mg/l for CRP.. PCT is able to differentiate between SIRS and sepsis while CRP is not. Moreover, unlike CRP, PCT concentrations varied with the evolution of sepsis.

Topics: Adolescent; Bacterial Infections; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cardiopulmonary Bypass; Child; Child, Preschool; Diagnosis, Differential; Female; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Male; Postoperative Complications; Prospective Studies; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome

Procalcitonin appears to be an early and sensitive marker of bacterial infection in a variety of clinical settings. The use of levels of procalcitonin to predict infection in children undergoing cardiac surgery, however, may be complicated by the systemic inflammatory response that normally accompanies cardiopulmonary bypass. The aim of our study was to estimate peri-operative concentrations of procalcitonin in non-infected children undergoing cardiac surgery. Samples of serum for assay of procalcitonin were obtained in 53 patients at baseline, 24, 48, and 72 hours following cardiac surgery. Concentrations were assessed using an immunoluminetric technique. Median concentrations were lowest at baseline at less than 0.5 nanograms per millilitre, increased at 24 hours to 1.8 nanograms per millilitre, maximized at 48 hours at 2.1 nanograms per millilitre, and decreased at 72 hours to 1.3 nanograms per millilitre, but did not return to baseline levels. Ratios of concentrations between 24, 48 and 72 hours after surgery as compared to baseline were 6.15, with 95 percent confidence intervals between 4.60 and 8.23, 6.49, with 95 percent confidence intervals from 4.55 to 9.27, and 4.26, with 95 percent confidence intervals between 2.78 and 6.51, respectively, with a p value less than 0.001. In 8 patients, who had no evidence of infection, concentrations during the period from 24 to 72 hours were well above the median for the group. We conclude that concentrations of procalcitonin in the serum increase significantly in children following cardiac surgery, with a peak at 48 hours, and do not return to baseline within 72 hours of surgery. A proportion of patients, in the absence of infection, had exaggerated elevations post-operatively.

Topics: Adolescent; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Child; Child, Preschool; Female; Follow-Up Studies; Glycoproteins; Heart Defects, Congenital; Humans; Infant; Male; Postoperative Period; Prognosis; Prospective Studies; Protein Precursors; Surgical Wound Infection

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.. 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.. 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).. 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.

Topics: Calcitonin; Calcitonin Gene-Related Peptide; Cardiopulmonary Bypass; Child, Preschool; Female; Heart Defects, Congenital; Humans; Infant; Interleukin-6; Male; Protein Precursors; Time Factors

The aim of our study was to investigate the systemic inflammatory response in children with congenital heart disease undergoing surgical correction with cardiopulmonary bypass. We wanted to discuss interleukin 6 and procalcitonin as components of the systemic inflammatory response syndrome to cardiopulmonary bypass and evaluate postoperative kinetics of these parameters in case of an uncomplicated course.. Procalcitonin and interleukin 6 were determined before and after cardiopulmonary bypass surgery in 37 children on the day of surgery, the first and fourth postoperative day. The increased procalcitonin and interleukin 6 levels were evaluated in relationship to intraoperative variables such as duration of aortic cross clamping, incisional trauma and cardiac bypass temperature.. Peak levels of procalcitonin were detected on the first postoperative day, while interleukin 6 reached its highest values on the day of surgery. In contrast to interleukin 6 the median values of procalcitonin differed significantly between short versus long aortic clamping time and atriotomy versus ventriculotomy. Interleukin 6 reached normal levels on the fourth postoperative day, while procalcitonin was still clearly above normal.. Serum concentrations of procalcitonin and interleukin 6 were influenced by systemic inflammatory response syndrome following cardiac surgery with cardiopulmonary bypass. Even in case of an uncomplicated course both parameters were elevated for at least four days. While procalcitonin serum concentrations were dependent on aortic clamping time or incisional trauma, interleukin 6 showed no significant relation with these intraoperative variables.

Topics: Calcitonin; Calcitonin Gene-Related Peptide; Cardiopulmonary Bypass; Child; Child, Preschool; Female; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Interleukin-6; Male; Protein Precursors

Postoperative measurement of cardiac troponin I, creatine kinase and procalcitonin reflects myocardial damage and systemic inflammatory response after cardiac surgery with cardiopulmonary bypass in children. Pulse-contour cardiac output technique is a less invasive tool for determining postoperative cardiac function.. The aim of our study was to investigate myocardial lesions and systemic inflammatory response after cardiac surgery with cardiopulmonary bypass in children suffering from congenital heart defects.. The elevation of cardiac troponin I (cTnI), creatine kinase (CK) and procalcitonin (PCT) was evaluated in relationship to duration of aortic cross-clamping, incisional trauma and cardiac bypass temperature in 37 paediatric patients. To assess postoperative cardiac function, the cardiac index was measured in 7 children using the PiCCO (pulse contour cardiac output) technique.. CTnI and PCT both peaked on the day of surgery and slowly decreased postoperatively in case of an uncomplicated course. The median values of both parameters differed significantly from the day of surgery until the fourth postoperative day in children with an aortic cross-clamping time (CCT) longer than 80 minutes or after ventriculotomy in comparison to patients with shorter clamping times or atriotomy only. CK values showed similar results, but were less significant than cTnI. A relationship between cTnI, CK or PCT and the body temperature during cardiopulmonary bypass was not found. The cardiac indices (CI) measured by the PiCCO technique in the first 48 hours after surgery showed normal values.. In summary, perioperative measurement of cTnI, CK and PCT reflects myocardial damage and systemic inflammatory response and allows an improved peri- and postoperative management. PiCCO technique is an excellent, less invasive tool to determine postoperative cardiac function.

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cardiac Output; Cardiopulmonary Bypass; Child; Child Welfare; Child, Preschool; Creatine Kinase; Female; Heart; Heart Defects, Congenital; Humans; Infant; Infant Welfare; Infant, Newborn; Inflammation; Male; Myocardium; Postoperative Complications; Prospective Studies; Protein Precursors; Pulse; Surgical Instruments; Time Factors; Treatment Outcome; Troponin I