title: Adrenomedullin alterations related to cardiopulmonary bypass in infants with low cardiac output syndrome.
abstract: BACKGROUND
  Low cardiac output syndrome (LCOS) remains a major perioperative complications in infants subjected to open-heart surgery with cardiopulmonary bypass (CPB). The present study investigated whether perioperative blood assessment of a potent vasoactive peptide namely adrenomedullin (AM) can predict the risk of LCOS.
  
  
  METHODS
  We measured AM levels in 48 patients (LCOS: n = 9; controls: n = 39) undergone to open-heart surgery with CPB at five predetermined time points before, during and after the surgery. Clinical, laboratory and perioperative data were analyzed by a multiple logistic regression model.
  
  
  RESULTS
  AM significantly decreased (p < 0.01) during and after the surgical procedure exhibiting a dip at the end of the CPB. Multivariable analysis demonstrated significant correlations among LCOS, AM measured at the end of CPB (p < 0.001), and cooling duration (p < 0.05). AM at 27 pg/L cutoff achieved a sensitivity of 100% and a specificity of 64.1%, while cooling at 11-min cutoff combined a sensitivity of 55.6% and a specificity of 92.3% for LCOS prediction.
  
  
  CONCLUSIONS
  This study suggests that AM can constitute, alone or combined with standard parameters, a promising predictor of LCOS in infants subjected to open-heart surgery with CPB.
authors.affiliation: Department of Pediatric Cardiac Surgery IRCCS, San Donato Milanese Hospital, San Donato Milanese, Italy.
authors.forename: Raul
authors.initials: R
authors.lastname: Abella
authors.forename: Angela
authors.initials: A
authors.lastname: Satriano
authors.forename: Alessandro
authors.initials: A
authors.lastname: Frigiola
authors.forename: Alessandro
authors.initials: A
authors.lastname: Varrica
authors.forename: Antonio Dw
authors.initials: AD
authors.lastname: Gavilanes
authors.forename: Luc J
authors.initials: LJ
authors.lastname: Zimmermann
authors.forename: Hans Js
authors.initials: HJ
authors.lastname: Vles
authors.forename: Pasquale
authors.initials: P
authors.lastname: Florio
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Calevo
authors.forename: Diego
authors.initials: D
authors.lastname: Gazzolo
mesh_terms: D053607:Adrenomedullin / Q000032:analysis / Q000097:blood*; D000367:Age Factors; D002303:Cardiac Output, Low / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000706:statistics & numerical data; D016022:Case-Control Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000151:congenital / Q000175:diagnosis / Q000453:epidemiology; D011379:Prognosis; D012680:Sensitivity and Specificity
chemical_list: D053607:Adrenomedullin