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Procalcitonin Is a Better Biomarker than C-Reactive Protein in Newborns Undergoing Cardiac Surgery: The PROKINECA Study

View Article: PubMed Central - PubMed

ABSTRACT

Objectives: To assess the kinetics of procalcitonin (PCT) and C-reactive protein (CRP) in newborns after cardiothoracic surgery (CS), with and without cardiopulmonary bypass, and to assess whether PCT was better than CRP in identifying sepsis in the first 72 hours after CS.

Patients and methods: This is a prospective study of newborns admitted to the neonatal intensive care unit after CS.

Interventions: PCT and CRP were sequentially drawn 2 hours before surgery and at 0, 12, 24, 48, and 72 hours after surgery.

Results: A total of 65 patients were recruited, of which 14 were excluded because of complications. We compared the kinetics of PCT and CRP after CS in bypass and non-bypass groups without sepsis; there were no differences in the PCT values at any time (24 hours, P = 0.564; 48 hours, P = 0.117; 72 hours, P = 0.076). Thirty-five patients needed bypass, of whom four were septic (11.4%). Significant differences were detected in the PCT values on comparing the septic group to the nonseptic group at 48 hours after cardiopulmonary bypass (P = 0.018). No differences were detected in the CRP values in these groups. A suitable cutoff for sepsis diagnosis at 48 hours following bypass would be 5 ng/mL, with optimal area under the curve of 0.867 (confidence interval 0.709–0.958), P < 0.0001, and sensitivity and specificity of 87.5% (29.6–99.7) and 72.6% (53.5–86.4), respectively.

Conclusion: This is a preliminary study but PCT seems to be a good biomarker in newborns after CS. Values over 5 ng/mL at 48 hours after CS should alert physicians to the high risk of sepsis in these patients.

No MeSH data available.


Related in: MedlinePlus

Differences in C-reactive protein values in terms of the diagnosis of sepsis, related to time.Note: Values expressed by median (p 25–75).Abbreviations: CPB-NS, nonseptic cardiopulmonary bypass; CPB-S, septic cardiopulmonary bypass; CRP, C-reactive protein (mg/L).
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f3-bmi-11-2016-123: Differences in C-reactive protein values in terms of the diagnosis of sepsis, related to time.Note: Values expressed by median (p 25–75).Abbreviations: CPB-NS, nonseptic cardiopulmonary bypass; CPB-S, septic cardiopulmonary bypass; CRP, C-reactive protein (mg/L).

Mentions: In CPB patients, there were no differences regarding PCT values in terms of the presence or absence of sepsis, statistically significant differences between PCT values were not found at 0 or 12 hours after ST (0.1831 and 0.1515, respectively). At 24 hours, PCT median values were higher in septic patients, but the difference did not achieve significance, 2.5 ng/mL (1.5–6.4 ng/mL) versus 11.25 ng/mL (3.2–37.6 ng/mL), 0.1948. At 48 and 72 hours, PCT results were significantly higher in septic patients, 0.0183 and 0.0111. The analysis of CRP data did not demonstrate significant differences at any time in terms of the presence of sepsis. All data are shown in Figures 2 and 3. There were no differences found in leukocytosis after surgery (at 24, 48, and 72 hours, 0.550, 0.140, and 0.389, respectively).


Procalcitonin Is a Better Biomarker than C-Reactive Protein in Newborns Undergoing Cardiac Surgery: The PROKINECA Study
Differences in C-reactive protein values in terms of the diagnosis of sepsis, related to time.Note: Values expressed by median (p 25–75).Abbreviations: CPB-NS, nonseptic cardiopulmonary bypass; CPB-S, septic cardiopulmonary bypass; CRP, C-reactive protein (mg/L).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC5096765&req=5

f3-bmi-11-2016-123: Differences in C-reactive protein values in terms of the diagnosis of sepsis, related to time.Note: Values expressed by median (p 25–75).Abbreviations: CPB-NS, nonseptic cardiopulmonary bypass; CPB-S, septic cardiopulmonary bypass; CRP, C-reactive protein (mg/L).
Mentions: In CPB patients, there were no differences regarding PCT values in terms of the presence or absence of sepsis, statistically significant differences between PCT values were not found at 0 or 12 hours after ST (0.1831 and 0.1515, respectively). At 24 hours, PCT median values were higher in septic patients, but the difference did not achieve significance, 2.5 ng/mL (1.5–6.4 ng/mL) versus 11.25 ng/mL (3.2–37.6 ng/mL), 0.1948. At 48 and 72 hours, PCT results were significantly higher in septic patients, 0.0183 and 0.0111. The analysis of CRP data did not demonstrate significant differences at any time in terms of the presence of sepsis. All data are shown in Figures 2 and 3. There were no differences found in leukocytosis after surgery (at 24, 48, and 72 hours, 0.550, 0.140, and 0.389, respectively).

View Article: PubMed Central - PubMed

ABSTRACT

Objectives: To assess the kinetics of procalcitonin (PCT) and C-reactive protein (CRP) in newborns after cardiothoracic surgery (CS), with and without cardiopulmonary bypass, and to assess whether PCT was better than CRP in identifying sepsis in the first 72 hours after CS.

Patients and methods: This is a prospective study of newborns admitted to the neonatal intensive care unit after CS.

Interventions: PCT and CRP were sequentially drawn 2 hours before surgery and at 0, 12, 24, 48, and 72 hours after surgery.

Results: A total of 65 patients were recruited, of which 14 were excluded because of complications. We compared the kinetics of PCT and CRP after CS in bypass and non-bypass groups without sepsis; there were no differences in the PCT values at any time (24 hours, P = 0.564; 48 hours, P = 0.117; 72 hours, P = 0.076). Thirty-five patients needed bypass, of whom four were septic (11.4%). Significant differences were detected in the PCT values on comparing the septic group to the nonseptic group at 48 hours after cardiopulmonary bypass (P = 0.018). No differences were detected in the CRP values in these groups. A suitable cutoff for sepsis diagnosis at 48 hours following bypass would be 5 ng/mL, with optimal area under the curve of 0.867 (confidence interval 0.709–0.958), P < 0.0001, and sensitivity and specificity of 87.5% (29.6–99.7) and 72.6% (53.5–86.4), respectively.

Conclusion: This is a preliminary study but PCT seems to be a good biomarker in newborns after CS. Values over 5 ng/mL at 48 hours after CS should alert physicians to the high risk of sepsis in these patients.

No MeSH data available.


Related in: MedlinePlus