Modern Biomarkers as Predictors of Postoperative Lower Respiratory Tract Infection Development in Newborns and Children with Congenital Heart Diseases

Artem Khrustalev, Dmitry Popov, Marina Plyushch, Olga Podshchekoldina

Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russia

Date, time and location: 2018.05.26 13:30, Press Hall, 2F

Abstract

Objective: To study the prognostic value of pro-adrenomedullin (MR-proADM), procalcitonin (PCT) and presepsin (PSP) as predictors of lower respiratory tract infection (LRTI) development in newborns and children undergone cardiac surgery with cardiopulmonary bypass.

Methods: The study included 42 patients aged 153 (44-252) days (from 4 to 360 days). Before surgery all patients had no clinical and laboratory signs of infection. Blood levels of above mentioned biomarkers, as well as C-reactive protein (CRP) and leukocytes count were measured before and on the 1st, 3d and 6th days after surgery. Data are presented as medians with interquartile range. The Mann-Whitney U-test was used to compare the data, p<0.05 was considered statistically significant.

Results: Twenty six patients (62%) developed LRTI (bronchitis/pneumonia) postoperatively. Compared with no-LRTI group, patients with LRTI had significantly higher levels of MR-proADM (3.39 (2.43-4.35) vs. 1.74 (0.9-2.56) nmol/L, p=0.00004) and PCT (9.4 (2.7-41.7) vs. 0.3 (0.11-1.75) ng/mL, p=0.0003) on the 1st day after surgery, which persisted during further period of the study. The levels of PSP were significantly higher only on the 1st day after surgery: 964 (648-1294) vs. 338 (214-924) pg/mL, p=0.03 with a tendency to remain higher on days 3-6 postoperatively. By the ROC-analysis, AUC ROC for MR-proADM, PCT and PSP on the 1st day after surgery as predictors of LRTI were 0.88 (95% CI 0.78-0.99), cut-off 2.36 nmol/L, Se. 80%, Sp. 79%; 0.83 (95% CI 0.7-0.96), cut-off 2.2 ng/mL, Se. 77%, Sp. 79% and 0.81 (95% CI 0.58-0.97), cut-off 621 pg/mL, Se. 78%, Sp. 71%, respectively. The levels of leukocytes and CRP were not differ between patients with and without LRTI during whole studied period.

Conclusions: MR-proADM, PCT and PSP can be used as early predictors of postoperative LRTI development in newborns and children with congenital heart diseases. Compared to PCT and PSP, MR-proADM revealed better prognostic value.