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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

Sensitivity and specificity for procalcitonin (PCT) and C-reactive protein (CRP) with respect to the sepsis diagnosis in CPB patients at 48 and 72 hours after surgery, respectively.Abbreviations: AUC, area under the curve; CI, confidence interval.
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f4-bmi-11-2016-123: Sensitivity and specificity for procalcitonin (PCT) and C-reactive protein (CRP) with respect to the sepsis diagnosis in CPB patients at 48 and 72 hours after surgery, respectively.Abbreviations: AUC, area under the curve; CI, confidence interval.

Mentions: Comparison of the AUC demonstrated greater sensitivity and specificity for PCT than for CRP in detecting sepsis after 48 hours of CPB with P-value < 0.0001 (Fig. 4 and Table 3). The best cutoff for PCT with respect to the sepsis diagnosis depended on post-ST. Approximations of the best cutoffs for PCT with maximum sensitivity and specificity, and the negative and positive predictive values for each time, are defined in Table 4.


Procalcitonin Is a Better Biomarker than C-Reactive Protein in Newborns Undergoing Cardiac Surgery: The PROKINECA Study
Sensitivity and specificity for procalcitonin (PCT) and C-reactive protein (CRP) with respect to the sepsis diagnosis in CPB patients at 48 and 72 hours after surgery, respectively.Abbreviations: AUC, area under the curve; CI, confidence interval.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f4-bmi-11-2016-123: Sensitivity and specificity for procalcitonin (PCT) and C-reactive protein (CRP) with respect to the sepsis diagnosis in CPB patients at 48 and 72 hours after surgery, respectively.Abbreviations: AUC, area under the curve; CI, confidence interval.
Mentions: Comparison of the AUC demonstrated greater sensitivity and specificity for PCT than for CRP in detecting sepsis after 48 hours of CPB with P-value < 0.0001 (Fig. 4 and Table 3). The best cutoff for PCT with respect to the sepsis diagnosis depended on post-ST. Approximations of the best cutoffs for PCT with maximum sensitivity and specificity, and the negative and positive predictive values for each time, are defined in Table 4.

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&ndash;0.958), P &lt; 0.0001, and sensitivity and specificity of 87.5% (29.6&ndash;99.7) and 72.6% (53.5&ndash;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