Procalcitonin Is a Better Biomarker than C-Reactive Protein in Newborns Undergoing Cardiac Surgery: The PROKINECA Study

OBJECTIVES: To assess the kinetics of procalcitonin (PCT) and C-reactive protein (CRP) in newborns after cardiothoracic surgery (CS), with and without cardiopulmonary bypass, and to assess whether POT was better than CRP in identifying sepsis in the first 72 hours after CS. PATIENTS ANT) METHODS: This is a prospective study of newborns admitted to the neonatal intensive care unit after CS. INTERVENTIONS: PCT and CRP were sequentially drawn 2 hours before surgery and at 0, 12, 24, 48, and 72 hours after surgery. RESULTS: A total of 65 patients were recruited, of which 14 were excluded because of complications. We compared the kinetics of POT and CRP after CS in bypass and non-bypass groups without sepsis; there were no differences in the PCT values at any time (24 hours, P = 0.564; 48 hours, P = 0.117; 72 hours, P = 0.076). 'thirty-five patients needed bypass, of whom tour were septic (11.4%). Significant differences were detected in the PCT values on comparing the septic group to the nonseptic group at 48 hours after cardiopulmonary bypass (P=0.018). No differences were detected in the CRP values in these groups. A suitable cutoff for sepsis diagnosis at 48 hours following bypass would he 5 ng/mL, with optimal area under the curve of 0.867 (confidence interval 0.709-0.958), P < 0.0001, and sensitivity and specificity of 87.5% (29.6-99.7) and 72.6% (53.5-86.4), respectively. CONCLUSION: This is a preliminary study but PCT seems to he a good biomarker in newborns after CS. Values over 5 ng/mL at 48 hours atter CS should alert physicians to the high risk of sepsis in these patients.