Detection of postoperative sepsis in infants with the use of metabolic stress monitoring
W. J. Chwals, M. E. Fernandez, A. C. Jamie, B. J. Charles and J. T. Rushing
Department of Surgery, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC.
OBJECTIVES: To evaluate the ability of serial protein metabolic monitoring
to detect postoperative injury due to serious bacterial infection in
infants by comparing changes observed in these protein parameters with more
conventionally accepted indexes of infection. DESIGN: Retrospective review
of infants whose postoperative course was complicated by bacterial
infection compared with a matched cohort of infants in whom bacterial
infection did not develop postoperatively. SETTING: Neonatal and pediatric
intensive care units at the Wake Forest University Medical Center,
Winston-Salem, NC. PATIENTS: Critically ill infants (N = 40) recovering
from major surgical intervention. MAIN OUTCOME MEASURES: Serum C-reactive
protein, prealbumin, and tumor necrosis factor concentrations were compared
with the white blood cell count, immature-total neutrophil ratio, and body
temperature obtained within 24 hours before and following the new onset of
culture-established postoperative bacterial infection in 13 infants. These
infants were compared with a matched cohort of 27 infants in whom
postoperative bacterial infection did not develop. RESULTS: Only C-reactive
protein (P = .0001) and prealbumin (P = .0003) levels were significantly
altered in association with the onset of serious bacterial infection
(paired t test). The C-reactive protein levels were clearly superior to all
other variables in predicting postoperative infection (at cutoff point >
6.0 mg/dL; sensitivity, 92%; specificity, 96%). The predictive power of
prealbumin level was lower, but acceptable (at cutoff point < or = 9.0
mg/dL; sensitivity, 85%; specificity, 74%). CONCLUSIONS: Monitoring of
serial protein metabolic stress with C-reactive protein and prealbumin
levels in infants following operations is more effective than the white
blood cell count, immature-total neutrophil ratio, or temperature in
detecting serious postoperative infections.
