Pediatric Critical Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
J Intensive Care Med. 2012 May-Jun;27(3):191-6. doi: 10.1177/0885066610396642. Epub 2011 May 11.
Fever after cardiac surgery in children may be due to bacterial infection or noninfectious origin like systemic inflammatory response syndrome (SIRS) secondary to bypass procedure. A marker to distinguish bacterial from nonbacterial fever in these conditions is clinically important. The purpose of our study was to evaluate, in the early postcardiac surgery period, whether serial measurement of C-reactive protein (CRP) and its change over time (CRP velocity) can assist in detecting bacterial infection. A series of consecutive children who underwent cardiac surgery with bypass were tested for serum levels of CRP at several points up to 5 days postoperatively and during febrile episodes (>38.0°C). Findings were compared among febrile patients with proven bacterial infection (FWI group; sepsis, pneumonia, urinary tract infection, deep wound infection), febrile patients without bacterial infection (FNI group), and patients without fever (NF group). In all, 121 children were enrolled in the study, 31 in the FWI group, 42 in the FNI group, and 48 patients in the NF group. Ages ranged from 4 days to 17.8 years (median 19.0, mean 46 ± 56 months). There was no significant difference among the groups in mean CRP level before surgery, 1 hour, and 18 hours after. A highly significant interaction was found in the change in CRP over time by FWI group compared with FNI group (P < .001). Mean CRP velocity ([fCRP - 18hCRP]/[fever time (days) - 0.75 day]) was significantly higher in the infectious group (4.0 ± 4.2 mg/dL per d) than in the fever-only group (0.60 ± 1.6 mg/dL per d; P < .001). A CRP velocity of 4 mg/dL per d had a positive predictive value (PPV) of 85.7% for bacterial infection with 95.2% specificity. Serial measurements of CRP/CRP velocity after cardiac surgery in children may assist clinicians in differentiating postoperative fever due to bacterial infection from fever due to noninfectious origin.
儿童心脏手术后发热可能是由细菌感染引起的，也可能是非感染性的，如旁路手术后全身炎症反应综合征（SIRS）。区分这些情况下的细菌性发热和非细菌性发热的标志物在临床上非常重要。我们的研究目的是评估在心脏手术后早期，连续测量 C 反应蛋白（CRP）及其随时间的变化（CRP 速度）是否有助于检测细菌感染。一系列接受旁路心脏手术的连续儿童在术后 5 天内和发热时（>38.0°C）检测血清 CRP 水平。将发热伴有明确细菌感染的患者（FWI 组；败血症、肺炎、尿路感染、深部伤口感染）、发热无细菌感染的患者（FNI 组）和无发热的患者（NF 组）的检测结果进行比较。共有 121 名儿童入组，FWI 组 31 例，FNI 组 42 例，NF 组 48 例。年龄从 4 天至 17.8 岁（中位数 19.0，平均 46±56 个月）。手术前、手术后 1 小时和 18 小时，三组的平均 CRP 水平无显著差异。FWI 组与 FNI 组比较，CRP 随时间的变化存在显著的交互作用（P<0.001）。感染组的 CRP 速度（[fCRP-18hCRP]/[发热时间（天）-0.75 天]）明显高于发热组（4.0±4.2mg/dL/d；P<0.001）。CRP 速度为 4mg/dL/d 时，对细菌感染的阳性预测值（PPV）为 85.7%，特异性为 95.2%。儿童心脏手术后连续测量 CRP/CRP 速度有助于临床医生区分术后因细菌感染引起的发热和非感染性发热。
