title: Diagnosis of infection in paediatric veno-arterial cardiac extracorporeal membrane oxygenation: role of procalcitonin and C-reactive protein.
abstract: OBJECTIVE
  Plasma concentration of procalcitonin (PCT) and its value in the diagnosis of infection in paediatric patients treated with extracorporeal membrane oxygenation (ECMO) are undefined. This study aimed to define the levels of PCT and C-reactive protein (CRP) in paediatric cardiac ECMO patients and to determine their role in predicting infection, severity of organ dysfunction and clinical outcome.
  
  
  METHODS
  PCT and CRP plasma concentrations were measured daily in 20 consecutive infants and young children treated with veno-arterial ECMO. Each patient was examined daily for signs of infection and multiple organ dysfunction syndrome (MODS). A total of 139 patient days were classified for infection and MODS.
  
  
  RESULTS
  The median PCT and CRP plasma concentrations were not increased during infection: 2.4 vs 8.8 ng/ml and 223.8 vs 240.6 mg/l, in patients with vs without infection, respectively. PCT, but not CRP, was significantly elevated during MODS (10.9 vs 1.85 ng/ml) (P = 0.001). The area under the receiver operating characteristic (ROC) curve was 0.984 for PCT (95% confidence interval [CI], 0.962-1.000) compared with 0.347 for CRP (95% CI, 0.211-0.484) (P = 0.001). Only PCT differed significantly in patients weaned from ECMO who survived (2.6 ng/ml) vs patients not weaned from ECMO (10.5 ng/ml) (P = 0.001). The area under the ROC curve was 0.871 (95% CI, 0.786-0.956) compared with 0.261 for CRP (95% CI, 0.145-0.377) (P = 0.001).
  
  
  CONCLUSIONS
  Neither PCT nor CRP are reliable markers of infection in paediatric cardiac ECMO patients. However, high levels of PCT are associated with MODS. PCT may be used as a prognostic indicator of clinical outcome in this high-risk population.
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Rungatscher
authors.forename: Alberto
authors.initials: A
authors.lastname: Merlini
authors.forename: Fabrizio
authors.initials: F
authors.lastname: De Rita
authors.forename: Gianluca
authors.initials: G
authors.lastname: Lucchese
authors.forename: Luca
authors.initials: L
authors.lastname: Barozzi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Faggian
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mazzucco
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Luciani
mesh_terms: D002097:C-Reactive Protein / Q000378:metabolism*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007239:Infections / Q000097:blood* / Q000175:diagnosis; D016014:Linear Models; D008297:Male; D009102:Multiple Organ Failure / Q000097:blood / Q000175:diagnosis; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D018805:Sepsis / Q000097:blood / Q000175:diagnosis; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide