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

Abstract

Objective  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).

Methods  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.

Results  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).

Conclusions  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.

Keywords
Procalcitonin; Postoperative infections; Pediatric; Open-heart surgery; Cardiopulmonary bypass