Combining procalcitonin, c-reactive protein, and white blood cell count in predicting infections in pediatric open cardiac surgery with cardiopulmonary bypass

TL;DR

This study shows that combining procalcitonin with other biomarkers improves early infection prediction after pediatric heart surgery.

Contribution

The study introduces a combined biomarker model for early infection detection in pediatric cardiac surgery patients.

Findings

PCT alone on postoperative day 3 had limited predictive value (AUC 0.67).

Combining PCT with CRP and WBC improved infection prediction (AUC 0.81).

The combined model showed a 9.66 times higher hazard ratio for infection prediction.

Abstract

This study aimed to evaluate the validity of models using Procalcitonin (PCT) alone and PCT combined with other biomarkers to predict early infection after pediatric open-heart surgery with cardiopulmonary bypass (CPB).

A prospective observational study was conducted on children undergoing open-heart surgery with CPB, without preoperative infection. Procalcitonin, C-reactive protein (CRP), and white blood cell (WBC) count were measured preoperatively and on postoperative days 1 and 3. Postoperative infection was defined according to the Centers for Disease Control and Prevention 2008 criteria.

Fifty eligible cases were included, comprising 46 % males with a median age of 7 months (4–17). The AUC (area under the curve) for PCT on postoperative day 3 was 0.67 (0.51–0.82) (p = 0.085). The AUCs for the models combining PCT + CRP and PCT + WBC were 0.71 (0.57–0.86) (p = 0.014) and 0.72 (0.55–0.86) (p = 0.014), respectively. The AUC for the model combining PCT + CRP + WBC was 0.81 (0.69–0.93) (p = 0.002). The combination of PCT > 4.15 ng/ml, CRP > 22.03 mg/l, and WBC > 15.3 × 103/µl predicted infection with a hazard ratio 9.66 times (2.94–31.72) higher than PCT > 4.15 ng/ml alone (p < 0.05).

PCT measurement on the third postoperative day alone cannot predict infection in pediatric open-heart surgery with CPB. The combination of PCT with CRP and WBC may enhance early infection prediction, although further validation in larger, multicenter cohorts is warranted.

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