title: Risk stratification in neonates and infants submitted to cardiac surgery with cardiopulmonary bypass: a multimarker approach combining inflammatory mediators, N-terminal pro-B-type natriuretic peptide and troponin I.
abstract: Low cardiac output syndrome (LCOS) is a common problem following cardiac surgery with cardiopulmonary bypass (CPB) in neonates and infants, and its early recognition remains a challenging task. We aimed to test whether a multimarker approach combining inflammatory and cardiac markers provides complementary information for prediction of LCOS and death in children submitted to cardiac surgery with CPB. Forty-six children younger than 18 months with congenital heart defects were prospectively enrolled. No intervention was made. Blood samples were collected pre-operatively, during CPB and post-operatively (PO) for measurement of interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor (TNF)-alpha, cardiac troponin I (cTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Clinical data and outcome variables were recorded. Logistic regression was used to identify predictors of LCOS and death. Multivariate logistic regression identified pre-operative NT-proBNP and IL-8 4h PO as independent predictors of LCOS, while cTnI 4h PO and CPB length were independent predictors of death. The use of inflammatory and cardiac markers in combination improved sensitivity, negative predictive value and accuracy of the models. In conclusion, the combined assessment of inflammatory and cardiac biochemical markers can be useful for identifying young children at increased risk for LCOS and death after heart surgery with CPB.
authors.affiliation: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Hospital das Clinicas, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Campus Universitario, Ribeirao Preto, SP, Brazil. carmona@fmrp.usp.br
authors.forename: Fabio
authors.initials: F
authors.lastname: Carmona
authors.forename: Paulo H
authors.initials: PH
authors.lastname: Manso
authors.forename: Walter V A
authors.initials: WV
authors.lastname: Vicente
authors.forename: Margaret
authors.initials: M
authors.lastname: Castro
authors.forename: Ana P C P
authors.initials: AP
authors.lastname: Carlotti
mesh_terms: D015415:Biomarkers / Q000097:blood; D002303:Cardiac Output, Low / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000401:mortality; D016207:Cytokines / Q000097:blood*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D016207:Cytokines; D010446:Peptide Fragments; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain