P93 Utilization of procalcitonin as a diagnostic biomarker of paediatric ventilator-associated pneumonia in patients with congenital heart disease following cardiac surgery

Abstract

Introduction and objective Paediatric population undergoing cardiac surgery are high-risk group to develop nosocomial infection because of longer recovery time and complexity of the procedure. Ventilator-associated pneumonia (VAP) is a common non-cardiac postoperative complication encountered following cardiac surgery and has been associated with increased use of resources, morbidity, and mortality. Thus, an early and accurate diagnosis and treatment of this life-threatening complication is important. In this study, we investigated the diagnostic value of procalcitonin (PCT) as an early biomarker of VAP in post-cardiac surgery patients. Methodology This is a prospective cohort study conducted in the critical care unit of a specialty hospital. All paediatric patients with congenital heart disease ages 0 to 18 years old who underwent elective cardiac surgery and were exposed to mechanical ventilation for more than 2 days (>48 hours) with signs and symptoms of VAP based on the criteria established by the NNIS and CDC were included in the study. The preoperative and postoperative characteristics of the subjects were recorded. The level of PCT was measured on day 2 postintubation or on the day when VAP was suspected. All tests were done using enzyme-linked fluorescent assay technique. The population was divided into VAP and non-VAP group. Receiver operating characteristics analysis was used to determine the diagnostic parameters of PCT in diagnosing VAP. STATA 13.1 was used for data analysis. Results A total of 58 patients were enrolled in this study. No significant difference was observed in preoperative characteristics between the VAP and non-VAP group. The occurrence of postoperative complications (p=0.005), duration of ICU days (p=0.02), and mortality (p=0.005) were statistically significant in the VAP group when compared with the non-VAP group. The optimum diagnostic PCT cut-off value for VAP on the day of suspicion was 1.77 ng/ml, with a sensitivity of 74% and a specificity of 86%. The areas under the ROC curve was 0.84. Conclusion The result suggested that PCT may be utilized as a diagnostic biomarker for paediatric VAP following cardiac surgery.