title: Markedly elevated procalcitonin in early postoperative period in pediatric open heart surgery: a prospective cohort study.
abstract: BACKGROUND
  We encountered markedly elevated procalcitonin (PCT) among pediatric patients during the early postoperative period of open heart surgery. The purpose of this study is to investigate what factors are associated with the PCT elevation.
  
  
  METHODS
  Fifty-two pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) were enrolled. Plasma PCT, aspartate aminotransferase/alanine aminotransferase (AST/ALT), creatinine, lactate, and C-reactive protein (CRP) were measured on admission to ICU and during the postoperative period. The patients were categorized into high (group H) and low (group L) groups according to their peak PCT levels. Aorta cross-clamp (ACC), CPB time, ICU stay, mechanical ventilation period, peak AST/ALT, creatinine, lactate, and CRP levels were compared.
  
  
  RESULTS
  ACC and CPB times, ICU stay period, and mechanical ventilation period were significantly longer in group H compared with group L (118.7 ± 51.6 vs. 49.4 ± 43.5 min, 244.5 ± 65.7 vs. 122.9 ± 63.0 min, 7.9 ± 4.6 vs. 4.0 ± 4.5 days, and 6.3 ± 4.1 vs. 2.9 ± 4.2 days, respectively; p < 0.01). Peak AST and creatinine were significantly higher in group H compared with group L (999.0 ± 1,990.3 vs. 88.3 ± 43.0 U/l and 0.84 ± 0.77 vs. 0.41 ± 0.17 mg/dl, respectively; p < 0.05).
  
  
  CONCLUSIONS
  ACC and CPB time-related perioperative stress is associated with elevated PCT; an association between ICU stay and mechanical ventilation period, liver enzymes, and creatinine levels was observed. PCT may be a good predictor of postoperative severity and organ dysfunction.
authors.affiliation: Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601 Japan.
authors.forename: Etsuko
authors.initials: E
authors.lastname: Minami
authors.affiliation: Department of Anesthesiology, Nagoya City East Medical Center, Nagoya, Aichi, 464-8547 Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Ito
authors.affiliation: Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601 Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sugiura
authors.affiliation: Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601 Japan.
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Fujita
authors.affiliation: Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601 Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sasano
authors.affiliation: Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601 Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sobue
keywords: Cardiac surgery; Pediatric; Procalcitonin