title: Utility of clinical biomarkers to predict central line-associated bloodstream infections after congenital heart surgery.
abstract: BACKGROUND
  Central line-associated bloodstream infections is an important contributor of morbidity and mortality in children recovering from congenital heart surgery. The reliability of commonly used biomarkers to differentiate these patients has not been specifically studied.
  
  
  METHODS
  This was a retrospective cohort study in a university-affiliated children's hospital examining all patients with congenital or acquired heart disease admitted to the cardiovascular intensive care unit after cardiac surgery who underwent evaluation for a catheter-associated bloodstream infection.
  
  
  RESULTS
  Among 1260 cardiac surgeries performed, 451 encounters underwent an infection evaluation postoperatively. Twenty-five instances of central line-associated blood stream infections (CLABSI) and 227 instances of a negative infection evaluation were the subject of analysis. Patients with CLABSI tended to be younger (1.34 vs. 4.56 years, P=0.011) and underwent more complex surgery (RACHS-1 score 3.79 vs. 3.04, P=0.039). The 2 groups were indistinguishable in white blood cell, polymorphonuclears and band count at the time of their presentation. On multivariate analysis, CLABSI was associated with fever (adjusted odds ratio: 4.78; 95% CI: 1.6-5.8) and elevated C-reactive protein (CRP; adjusted odds ratio: 1.28; 95% CI: 1.09-1.68) after adjusting for differences between the 2 groups. Receiver-operating characteristic analysis demonstrated the discriminatory power of both fever and CRP (area under curve 0.7247, 95% CI: 0.42 to 0.74 and 0.58, 95% CI: 0.4208 to 0.7408). We calculated multilevel likelihood ratios for a spectrum of temperature and CRP values.
  
  
  CONCLUSIONS
  We found commonly used serum biomarkers such as fever and CRP not to be helpful discriminators in patients after congenital heart surgery.
authors.affiliation: From the *Division of Pediatric Cardiology, Department of Pediatrics, Stanford Cardiovascular Institute, Lucile Packard Children's Hospital; †Department of Pediatrics, Center for Clinical Effectiveness; ‡Division of Pediatric Surgery, Department of Surgery; §Division of Nephrology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, CA; and ¶Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR.
authors.forename: Andrew Y
authors.initials: AY
authors.lastname: Shin
authors.forename: Bo
authors.initials: B
authors.lastname: Jin
authors.forename: Shiying
authors.initials: S
authors.lastname: Hao
authors.forename: Zhongkai
authors.initials: Z
authors.lastname: Hu
authors.forename: Scott
authors.initials: S
authors.lastname: Sutherland
authors.forename: Amy
authors.initials: A
authors.lastname: McCammond
authors.forename: David
authors.initials: D
authors.lastname: Axelrod
authors.forename: Paul
authors.initials: P
authors.lastname: Sharek
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Roth
authors.forename: Xuefeng Bruce
authors.initials: XB
authors.lastname: Ling
mesh_terms: D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein; D055499:Catheter-Related Infections / Q000097:blood* / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000097:blood* / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein