Prevention of postoperative infectious complications with procalcitonin-controlled early postoperative administration of IgM-enriched immunoglobulin preparation in high-risk children with congenital heart diseases

Objectives

To evaluate the effectiveness of procalcitonin (PCT)-controlled use of IgM-enriched immunoglobulin preparation in high-risk children with congenital heart diseases after cardiac surgery with cardiopulmonary bypass (CPB).

Methods

During January–July 2004, 31 consecutive high-risk pediatric patients were enrolled into the study. The age was 23 (19–30) months. Severe concomitant extracardiac pathologies were registered in 22 (71%) of cases; 21 (68%) patients had preceding cardiovascular operations. Patients who had PCT blood plasma levels above 2 ng/ml on the first day after surgery (n = 28) were randomized into two groups. These groups were comparable by severity of initial condition, age and CPB time. IgM-enriched immunoglobulin preparation (Pentaglobin; Biotest Pharma GmbH, Germany) was administrated to the patients in the study group (n = 15) in addition to standard treatment (first 3 days after surgery, 5 ml/kg each day). Patients in the control group (n = 13) received only standard treatment. PCT blood plasma concentrations were measured by immunoluminometric method (PCT LIA; BRAHMS Aktiengesellschaft GmbH, Germany). The data are shown as median and 25th and 75th percentiles. The data were compared by Mann–Whitney U test, P < 0.05 considered statistically significant. Postoperative infections rates were analyzed in studied groups.

Results

None of the patients had exhibited any signs of infection before surgery. Patients with PCT blood plasma levels less than 2 ng/ml on the first day after surgery (n = 3) had a smooth postoperative period. PCT levels on the first day after surgery were significantly higher in the control group in comparison with the study group (7.77 [5.95–10.72] ng/ml and 3.60 [2.98–6.54] ng/ml, respectively; P = 0.009). Postoperatively 1/15 (6.7%) of patients in the study group and 5/13 (38.5%) of patients in the control group suffered from infectious complications (study group: urinary tract infection – one patient; control group: pneumonia – two patients, pneumonia and sepsis – one patient, peritonitis with multiorgan failure – one patient, urinary tract infection – one patient). The rate of postoperative infectious complications was significantly lower in the study group (P = 0.03). Two deaths in the control group occurred due to sepsis (n = 1) and peritonitis with multiorgan failure (n = 1).

Conclusions

High PCT levels on the first day after surgery are associated with high rates of infectious complications. PCT monitoring allows one to select patients with systemic bacterial inflammation after CPB. Early (on the first day after surgery) administration of IgM-enriched immunoglobulin preparation effectively prevents infectious complications in these patients.