Zhu Yu,Chen Xiaotian,Ye Ming,et al.Correlation between early postoperative inflammatory marker changes and antibiotic use in children with congenital heart disease[J].Journal of Clinical Pediatric Surgery,,():146-152.[doi:10.3760/cma.j.cn101785-202502003]
Correlation between early postoperative inflammatory marker changes and antibiotic use in children with congenital heart disease
- Keywords:
- Heart Diseases; Heart Diseases; Cardiac Surgical Procedures; Procalcitonin; C-Reactive Protein; Leukocyte Count; Anti-Bacterial Agents; Therapeutic Uses
- Abstract:
- Objective To explore the guiding value of early postoperative inflammatory marker changes for antibiotic use after surgery for congenital heart disease (CHD),and to provide evidence for postoperative anti-infective treatment in children with CHD. Methods This was a retrospective cohort study included 806 children who underwent surgery for CHD and were admitted to the Cardiac Care Unit of the Children’s Hospital of Fudan University between January 1,2021 and December 31,2022.Among them,448 were male and 358 were female,with a mean age of 3.07 years and a mean body weight of 14.50 kg.Baseline information and inflammatory markers on postoperative day 1,including white blood cell (WBC) count,C-reactive protein (CRP),and procalcitonin (PCT),were collected.According to whether postoperative antibiotics were escalated,patients were divided into an antibiotic escalation group (n=464) and a non-escalation group (n=342).Intergroup comparisons were performed using t-tests,rank-sum tests,and chi-square tests.Multivariate logistic regression analyses were conducted for WBC count,PCT,and CRP. Results Significant differences were observed between the two groups in age,body weight,height,Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1) score,cardiopulmonary bypass (CPB) time,and aortic cross-clamp time (P<0.001).Significant differences were also found in postoperative day 1 CRP,WBC and PCT levels between the two groups (P<0.001).CRP,WBC,and PCT levels were divided into four groups (Q1-Q4) from low to high according to the degree of elevation,and trend tests were performed.Moderate-to-marked elevations of WBC and PCT (Q3 and Q4) were associated with antibiotic escalation (P<0.05).The strongest associations were observed in the Q4 groups with the highest elevations of WBC(OR=3.74,95%CI:2.16-6.60,P<0.001) and PCT(OR=2.57,95%CI:1.56-4.27,P<0.001). Conclusions Younger age,lower body weight,and more complex cardiac surgery are associated with a higher likelihood of antibiotic escalation.Compared with CRP,marked early postoperative elevations in PCT and WBC count are more meaningful for guiding antibiotic use after surgery for CHD.
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Memo
收稿日期:2025-9-2。
基金项目:2024年医疗服务与保障能力提升(国家临床重点专科建设)(10000015Z155080000004);上海市2022年度"科技创新行动计划"医学创新研究专项(22Y11909300)
通讯作者:宓亚平,Email:miyaping126@126.com