Celebi Serdar, Koner Ozge, Menda Ferdi, Balci Huriye, Hatemi Alican, Korkut Kubilay, Esen Figen
Istanbul University, Cardiology Institute, Anesthesiology and Intensive Care Department, Istanbul, Turkey.
Intensive Care Med. 2006 Jun;32(6):881-7. doi: 10.1007/s00134-006-0180-z. Epub 2006 Apr 28.
To evaluate procalcitonin and C-reactive protein as markers of inflammation severity and their value in predicting development of organ failure after pediatric open heart surgery.
Prospective, observational, clinical study.
Single university hospital.
Thirty-three pediatric patients with systemic inflammatory response syndrome (SIRS; n=19) and SIRS+organ failure (SIRS+OF; n=14) following open heart surgery were included.
Plasma procalcitonin and C-reactive protein levels were measured before and after the operation, and 1, 2, 3, and 4 days after surgery. Patients were evaluated daily to assess organ failure. Postoperative procalcitonin levels in the SIRS+OF group were significantly higher than in the SIRS group. C-reactive protein levels were similar between the groups throughout the study period. Peak procalcitonin levels were found to be positively correlated with aortic cross-clamp and cardiopulmonary bypass times, duration of mechanical ventilation, intensive care unit and hospital stay, mortality and organ failure development. Peak procalcitonin was found to be a good predictor of postoperative organ failure development and mortality. However, the predictive value of peak C-reactive protein for organ failure and mortality was found to be weak. Double-peak procalcitonin curves were observed in SIRS+OF patients with infection during the intensive care unit stay.
In the SIRS+OF group peak procalcitonin levels were found to be highly predictive for mortality and organ failure development, whereas C-reactive protein levels were not. Daily procalcitonin measurements in SIRS+OF patients may help identify the postoperative infection during the follow-up period.
评估降钙素原和C反应蛋白作为炎症严重程度标志物及其在预测小儿心脏直视手术后器官功能衰竭发生方面的价值。
前瞻性、观察性临床研究。
单一大学医院。
纳入33例小儿心脏直视手术后发生全身炎症反应综合征（SIRS；n = 19）和SIRS + 器官功能衰竭（SIRS + OF；n = 14）的患者。
在手术前、后以及术后1、2、3和4天测量血浆降钙素原和C反应蛋白水平。每天对患者进行评估以评估器官功能衰竭。SIRS + OF组术后降钙素原水平显著高于SIRS组。在整个研究期间，两组间C反应蛋白水平相似。发现降钙素原峰值水平与主动脉阻断和体外循环时间、机械通气时间、重症监护病房和住院时间、死亡率以及器官功能衰竭的发生呈正相关。发现降钙素原峰值是术后器官功能衰竭发生和死亡率的良好预测指标。然而，发现C反应蛋白峰值对器官功能衰竭和死亡率的预测价值较弱。在重症监护病房住院期间，在发生感染的SIRS + OF患者中观察到降钙素原双峰曲线。
在SIRS + OF组中，发现降钙素原峰值水平对死亡率和器官功能衰竭的发生具有高度预测性，而C反应蛋白水平则不然。对SIRS + OF患者每日测量降钙素原可能有助于在随访期间识别术后感染。
