Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
J Surg Res. 2021 Feb;258:332-338. doi: 10.1016/j.jss.2020.09.028. Epub 2020 Oct 29.
Procalcitonin (PCT) is a biomarker of bacterial infections with more sensitivity and specificity than commonly used inflammatory markers. PCT can be particularly helpful in the postsurgical population where the surgery itself often leads to noninfectious inflammation. We aimed to examine the utility of perioperative profiles of PCT in predicting infection in two pediatric surgical populations.
We conducted a prospective observational study of perioperative PCT in children undergoing cardiac or neurosurgery. Consenting patients with no preoperative infection or immune deficiency were enrolled. We measured plasma PCT levels within 24 h preprocedure and 24-48 h postprocedure. Demographic, clinical, and laboratory data were collected from the medical records including clinical suspicion and confirmed infections. Perioperative PCT changes and their associations with these data are reported.
We enrolled 26 neuro and 15 cardiac surgery patients. There was postoperative clinical suspicion of infection in 3 neuro and 5 cardiac patients, and 1 neuro and 2 cardiac patients had subsequently confirmed infections. Cardiac patients had higher overall perioperative PCT increase than neuro cohort (P = 0.006). Neuro patient with infection had higher perioperative change in PCT (0.5 to 1.4 ng/mL) than noninfected neurosurgery patients. Cardiac patients with confirmed infections had higher postoperative levels which exceeded the previously described infection threshold of 2 ng/mL.
PCT is a useful early biomarker of postoperative infection in pediatric patients undergoing cardiac and neurosurgery. Patients who underwent cardiac surgery have significantly higher perioperative PCT rise than patients who underwent neurosurgery, and all patients with subsequently confirmed infections had at least 2-fold perioperative PCT increase.
降钙素原 (PCT) 是一种细菌感染的生物标志物，其敏感性和特异性均高于常用的炎症标志物。PCT 在术后人群中特别有用，因为手术本身常常导致非感染性炎症。我们旨在研究两个儿科手术人群中围手术期 PCT 谱在预测感染中的作用。
我们对接受心脏或神经外科手术的儿童进行了一项前瞻性观察性研究。纳入了无术前感染或免疫缺陷且同意的患者。我们在术前 24 小时内和术后 24-48 小时内测量血浆 PCT 水平。从病历中收集了人口统计学、临床和实验室数据，包括临床怀疑和确诊感染。报告了围手术期 PCT 变化及其与这些数据的关系。
我们纳入了 26 例神经外科和 15 例心脏手术患者。3 例神经患者和 5 例心脏患者术后有临床感染怀疑，1 例神经患者和 2 例心脏患者随后确诊感染。心脏患者的总体围手术期 PCT 升高高于神经组（P=0.006）。感染的神经患者的 PCT 围手术期变化高于未感染的神经手术患者（0.5 至 1.4ng/mL）。确诊感染的心脏患者术后 PCT 水平更高，超过了之前描述的 2ng/mL 的感染阈值。
PCT 是心脏和神经外科术后儿童感染的有用早期生物标志物。接受心脏手术的患者的围手术期 PCT 升高明显高于接受神经外科手术的患者，所有随后确诊感染的患者的 PCT 均有至少 2 倍的围手术期升高。
