Can the Systemic Immune-Inflammatory Index Predict Nosocomial Infection in Term Newborns Who Underwent Congenital Cardiac Surgery?
Selin Sağlam1, Erkut Öztürk2, Şerife Özalp1, Ibrahim Cansaran Tanıdır2, Funda Gümüş Özcan1, Ali Can Hatemi31Department of Anesthesiology and Reanimation, University of Health Sciences, Başakşehir Çam and Sakura Hospital, İstanbul, Türkiye2Department of Pediatric Cardiology, University of Health Sciences, University Başakşehir Çam and Sakura Hospital, İstanbul, Türkiye
3Department of Pediatric Cardiac Surgery, University of Health Sciences, Başakşehir Çam and Sakura Hospital, İstanbul, Türkiye
Objectives: In this study, we aimed to investigate the contribution of the early systemic immune-inflammatory index (SII) and acute-phase reactants in predicting nosocomial infections in term newborns who underwent congenital heart surgery.
Methods: This retrospective study was conducted in neonates who underwent cardiopulmonary bypass (CPB) surgery for congenital heart disease (CHD) between November 1, 2021, and December 1, 2022, and were followed in the pediatric cardiac intensive care unit. Demographic and clinical characteristics, as well as changes in the systemic inflammatory index (platelet count×neutrophil/lymphocyte count) and acute-phase reactants during the preoperative period and the first 72 postoperative hours, were evaluated in patients with and without nosocomial infection. The results were statistically analyzed.
Results: This study included 160 neonatal patients. The median age was 10 days (IQR, 6–15 days), and the median weight was 3 kg (IQR, 2.8–3.2 kg). Eighty patients were male (50%). Fifty-five different nosocomial infections were identified in 44 patients (27.5%). Bloodstream infections were the most common (62%), followed by lower respiratory tract infections (23%) and wound infections (15%). Mortality due to nosocomial infections was 34%. SII and NLR values measured on postoperative days 2 and 3 were significantly higher in patients with nosocomial infections (p<0.05). An SII value >510 (72% specificity, 85% sensitivity) on postoperative day 2 and >730 (72% specificity, 80% sensitivity) on postoperative day 3 were highly predictive of nosocomial infection.
Conclusions: Nosocomial infections are an important cause of mortality and morbidity in neonates undergoing congenital heart surgery. An easy-to-use systemic inflammatory index measurement may help predict nosocomial infections.
Keywords: Congenital heart disease, newborn, nosocomial infections, systemic inflammatory index
Manuscript Language: English