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CC BY-NC-ND 4.0 · Avicenna J Med 2017; 07(04): 182-188
DOI: 10.4103/ajm.AJM_51_17
ORIGINAL ARTICLE

Can acute-phase response biomarkers differentiate infection from inflammation postpediatric cardiac surgery?

Bana Agha Nasser
Prince Sultan Cardiac Center, Pediatric Cardiac Intensive Care, Qassim, Kingdom of Saudi Arabia
,
Abdu Rahman Mesned
Prince Sultan Cardiac Center, Pediatric Cardiac Intensive Care, Qassim, Kingdom of Saudi Arabia
,
Mohamad Tageldein
Prince Sultan Cardiac Center, Pediatric Cardiac Surgery, Qassim, Kingdom of Saudi Arabia
,
Mohamed S Kabbani
Department of Cardiac Sciences, Pediatric Cardiac Intensive Care, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
,
Nada Siddig Sayed
Prince Sultan Cardiac Center, Pediatric Cardiac Surgery, Qassim, Kingdom of Saudi Arabia
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Background: Infection is a common serious complication postpediatric cardiac surgery. Diagnosis of infection after cardiopulmonary bypass (CPB) is difficult in the presence of surgical stress, hemodynamic instability, and inflammatory reaction. Aim: The purpose of this study is to investigate the value of available inflammatory biomarkers and its validity to differentiate infection from inflammation postpediatric cardiac surgery and to find the trend and the change in the level of these biomarkers shortly after cardiac surgery. Methods: We conducted a prospective study that included all children who underwent cardiac surgery in Prince Sultan Cardiac Centre-Qassim from November 2013 to October 2015. C-reactive protein, erythrocyte sedimentation rate, white blood cell count, and neutrophil count were measured for all patients presurgery, 4 consecutive days postsurgery, and predischarge. Patients were divided into two groups (the infected and the noninfected group). We compared the level of biomarkers between both groups. Then, we further analyzed the effects of CPB and preoperative steroid on postoperative inflammatory biomarker levels. Collected data were then reviewed and analyzed. Results: There were 134 pediatric cardiac patients included during the study period. Group 1 (bacterial negative culture group) had 125 cases and Group 2 (bacterial positive culture group) had nine cases. We found no statistically significant difference in inflammatory biomarker elevation between both groups. Only Group 2 had higher (RACHS) Risk adjustment for congenital heart surgery score, more ventilator days, and more drop in platelet count on the 2nd and 3rd postoperative days in comparison with the noninfected group 1. Both groups of patients who were in on and off CPB had the same level of inflammatory biomarkers with no significant differences. Giving corticosteroid preoperatively did not affect the trend of biomarker elevation and made no difference when it was compared to the group of patients who did not receive corticosteroid before surgery. Conclusion: Common inflammatory biomarkers cannot differentiate between infection and inflammation within the first 5 days postpediatric cardiac surgery as these reflect the inflammatory process rather than infection. Trend is more important than single reading.

Keywords

Cardiopulmonary bypass - C-reactive protein - infection - inflammation - pediatric cardiac surgery


Publication History

Article published online:
09 August 2021

© 2017. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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