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

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 va...

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Autores principales:	Bana Agha Nasser, Abdu Rahman Mesned, Mohamad Tageldein, Mohamed S Kabbani, Nada Siddig Sayed
Formato:	article
Lenguaje:	EN
Publicado:	Thieme Medical and Scientific Publishers Pvt. Ltd. 2017
Materias:	cardiopulmonary bypass c-reactive protein infection inflammation pediatric cardiac surgery Medicine R
Acceso en línea:	https://doaj.org/article/e0fe0838c8f240469607091be67f5c21
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spelling	oai:doaj.org-article:e0fe0838c8f240469607091be67f5c212021-12-02T16:24:58ZCan acute-phase response biomarkers differentiate infection from inflammation postpediatric cardiac surgery?2231-07702249-446410.4103/ajm.AJM_51_17https://doaj.org/article/e0fe0838c8f240469607091be67f5c212017-10-01T00:00:00Zhttp://www.thieme-connect.de/DOI/DOI?10.4103/ajm.AJM_51_17https://doaj.org/toc/2231-0770https://doaj.org/toc/2249-4464Background: 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.Bana Agha NasserAbdu Rahman MesnedMohamad TageldeinMohamed S KabbaniNada Siddig SayedThieme Medical and Scientific Publishers Pvt. Ltd.articlecardiopulmonary bypassc-reactive proteininfectioninflammationpediatric cardiac surgeryMedicineRENAvicenna Journal of Medicine, Vol 07, Iss 04, Pp 182-188 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	cardiopulmonary bypass c-reactive protein infection inflammation pediatric cardiac surgery Medicine R
spellingShingle	cardiopulmonary bypass c-reactive protein infection inflammation pediatric cardiac surgery Medicine R Bana Agha Nasser Abdu Rahman Mesned Mohamad Tageldein Mohamed S Kabbani Nada Siddig Sayed Can acute-phase response biomarkers differentiate infection from inflammation postpediatric cardiac surgery?
description	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.
format	article
author	Bana Agha Nasser Abdu Rahman Mesned Mohamad Tageldein Mohamed S Kabbani Nada Siddig Sayed
author_facet	Bana Agha Nasser Abdu Rahman Mesned Mohamad Tageldein Mohamed S Kabbani Nada Siddig Sayed
author_sort	Bana Agha Nasser
title	Can acute-phase response biomarkers differentiate infection from inflammation postpediatric cardiac surgery?
title_short	Can acute-phase response biomarkers differentiate infection from inflammation postpediatric cardiac surgery?
title_full	Can acute-phase response biomarkers differentiate infection from inflammation postpediatric cardiac surgery?
title_fullStr	Can acute-phase response biomarkers differentiate infection from inflammation postpediatric cardiac surgery?
title_full_unstemmed	Can acute-phase response biomarkers differentiate infection from inflammation postpediatric cardiac surgery?
title_sort	can acute-phase response biomarkers differentiate infection from inflammation postpediatric cardiac surgery?
publisher	Thieme Medical and Scientific Publishers Pvt. Ltd.
publishDate	2017
url	https://doaj.org/article/e0fe0838c8f240469607091be67f5c21
work_keys_str_mv	AT banaaghanasser canacutephaseresponsebiomarkersdifferentiateinfectionfrominflammationpostpediatriccardiacsurgery AT abdurahmanmesned canacutephaseresponsebiomarkersdifferentiateinfectionfrominflammationpostpediatriccardiacsurgery AT mohamadtageldein canacutephaseresponsebiomarkersdifferentiateinfectionfrominflammationpostpediatriccardiacsurgery AT mohamedskabbani canacutephaseresponsebiomarkersdifferentiateinfectionfrominflammationpostpediatriccardiacsurgery AT nadasiddigsayed canacutephaseresponsebiomarkersdifferentiateinfectionfrominflammationpostpediatriccardiacsurgery
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Can acute-phase response biomarkers differentiate infection from inflammation postpediatric cardiac surgery?

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