Procalcitonin, neopterin and C-reactive protein after pediatric cardiac surgery with cardiopulmonary bypass.
BACKGROUND
Kinetics of activation of newly introduced inflammatory markers is of particular value in their use in postoperative setting after pediatric cardiac surgery.


OBJECTIVE
To assess the influence of cardiopulmonary bypass (CPB) on activation of inflammatory markers.


METHODS
Procalcitonin, neopterin and C-reactive protein (CRP) blood levels were measured before, on day 1 and day 2 after surgery in 152 pediatric patients undergoing cardiac surgery with CPB. All patients had infection-free postoperative course.


RESULTS
Procalcitonin blood levels increased from 0.08 (0.001-0.19) ng/mL before surgery to 0.79 (0.13-3.5) ng/mL on day 1 (p < 0.001) and 0.52 (0.07-2.7) ng/mL on day 2 (p < 0.001) after surgery. Procalcitonin levels on day 1 correlated with CPB duration, cross-clamping time and use of aprotinin. Neopterin values increased from 8.4 (4.4-32) nmol/L before surgery to 16.1 (6.8-37.6) nmol/L on day 1 (p < 0.001) and 10.9 (5.3-31.1) nmol/L on day 2 (p < 0.001) after surgery. Neopterin levels on day 1 correlated negatively with age, lowest esophageal temperature and use of aprotinin; and positively with circulatory arrest, length of stay and use of modified ultrafiltration. CRP values increased from 4.7 (2.7-9.6) mg/L before surgery to 38.8 (13-73.5) mg/L (p < 0.001) on day 1 and 38.3 (15-88) mg/L (p < 0.001) on day 2 after surgery. CRP levels correlated positively with age at surgery, use of aprotinin and lowest esophageal temperature; and negatively with circulatory arrest and modified ultrafiltration.


CONCLUSIONS
Procalcitonin and neopterin levels peaked on day 1, CRP levels remained elevated during first two postoperative days. Neopterin and CRP had age dependent kinetics (Tab. 2, Fig. 2, Ref. 18). Full Text (Free, PDF) www.bmj.sk.
Skrak
P
P
Cardiac Intensive Care Unit, Pediatric Cardiac Center, Bratislava, Slovakia. skrak@dkc-sr.sk
Kovacikova
L
L
Kunovsky
P
P
D000293:Adolescent; D002097:C-Reactive Protein / Q000032:analysis*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D006023:Glycoproteins / Q000097:blood; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019798:Neopterin / Q000097:blood*; D011498:Protein Precursors / Q000097:blood*
C000606589:CALCA protein, human; D006023:Glycoproteins; D011498:Protein Precursors; D019798:Neopterin; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide