Aryafar A, Di Marzio A, Guillard O, Pontailler M, Vicca S, Bojan M
Department of Neonatology, Necker-Enfants Malades Hospital, 149 rue de Sèvres, 75743, Paris Cedex 15, France.
Department of Neonatology, Centre Hospitalier Sud Francilien, 40 Avenue Serge Dassault, 91100, Corbeil-Essonnes, France.
Pediatr Cardiol. 2019 Aug;40(6):1289-1295. doi: 10.1007/s00246-019-02150-y. Epub 2019 Jul 16.
Increased procalcitonin concentration (PCT) is known to be reliable for the identification of infections even in the presence of the non-specific systemic inflammatory response seen after cardiopulmonary bypass (CPB), whereas increased C-reactive protein concentration (CRP) is not. The present work explored the ability of neonate PCT measured early after cardiac surgery to identify postoperative infections. This was a retrospective case-control study, where PCT was matched between patients with and without infections according to the patient's age, the CPB length, the use of deep hypothermic circulatory arrest (DHCA), and the postoperative day (POD). The accuracy in the prediction of infections was ascertained and cutoff thresholds were identified. 144 neonates were eligible, and 89 pairs of measurements from 94 patients were analyzed. PCT was a good predictor of infections within POD4, and was a better predictor when compared with CRP at POD1 and POD2. The sum of PCT (pg mL) and CRP (mg L) > 33 on POD1 or POD2 predicted infections with a 0.68 sensitivity and a 0.82 specificity, and a sum > 49.36 on POD3 or POD4 predicted infections with a 0.82 sensitivity and a 0.93 specificity. In patients with DHCA, PCT was higher than in those without DHCA, and was not predictive of infections. The accuracy of PCT to identify infections after neonatal cardiac surgery is better than that of CRP when measured within 48 h of surgery. The sum of the two markers measured early after surgery is an excellent predictor of postoperative infections.
即使在体外循环（CPB）后出现非特异性全身炎症反应的情况下，降钙素原（PCT）浓度升高也被认为是识别感染的可靠指标，而C反应蛋白（CRP）浓度升高则不然。本研究探讨了心脏手术后早期检测新生儿PCT以识别术后感染的能力。这是一项回顾性病例对照研究，根据患者年龄、CPB时长、是否使用深低温停循环（DHCA）和术后天数（POD），对有感染和无感染患者的PCT进行匹配。确定了预测感染的准确性并确定了临界阈值。144例新生儿符合条件，对94例患者的89对测量值进行了分析。PCT是POD4内感染的良好预测指标，与POD1和POD2时的CRP相比，是更好的预测指标。POD1或POD2时PCT（pg/mL）与CRP（mg/L）之和>33预测感染的灵敏度为0.68，特异度为0.82；POD3或POD4时之和>49.36预测感染的灵敏度为0.82，特异度为0.93。在接受DHCA的患者中，PCT高于未接受DHCA的患者，但不能预测感染。新生儿心脏手术后48小时内检测，PCT识别感染的准确性优于CRP。术后早期检测的两种标志物之和是术后感染的优秀预测指标。
