title: Prognostic significance of sICAM-1 and sVCAM-1 molecules for cardiac surgery in pediatric patients with pulmonary hypertension.
abstract: OBJECTIVE
  To investigate preoperative and postoperative blood levels of soluble intercellular and vascular cell adhesion molecules (sICAM-1, sVCAM-1) in patients with and without pulmonary hypertension (PAH) due to congenital heart disease and left to right (L-R) shunt and to determine whether these molecules can be used as reliable prognostic markers of endothelial activity to predict surgical outcomes.
  
  
  METHODS
  In this observational prospective cohort study; 42 patients, operated for L-R shunt were divided into three groups. Group 1: L-R shunt without PAH, Group 2: L-R shunt with PAH, Group 3: L-R shunt with PAH and postoperative low cardiac output syndrome (LCOS). Their sICAM-1 and sVCAM-1 levels were measured preoperatively (sICAM-0, sVCAM-0) and on the first (sICAM-1, sVCAM-1) and fifth postoperative days (sICAM-2, sVCAM-2).ROC curve for various cut-off levels of sICAM-0, sVCAM-0 in differentiating PAH patients with and without LCOS.
  
  
  RESULTS
  In Group 3, sICAM-0 and sVCAM-2 levels were higher than Group 1 and 2. The ROC curve demonstrated a significant association between sICAM-0 in patients with L-R shunt and PAH (Group 2 and 3) and the development of LCOS (area under the curve: 0.98, p<0.01 and 0.97, p<0.01, respectively). At a sICAM-0 concentration >359 ng/mL, there was a sensitivity of 90% and specificity of 95% for identification of LCOS in patients with L-R shunt and PAH (AUC: 0.98, 95% CI: 0.95-1.02, p<0.01).
  
  
  CONCLUSIONS
  High preoperative sICAM-1 molecule may be used to predict postoperative dichotomous outcome in patients with PAH associated with L-R shunt.
authors.affiliation: Clinics of Pediatric Cardiology, Kartal Koşuyolu Training and Research Heart Hospital; İstanbul-Turkey. nacioner@yahoo.com.
authors.forename: Ayşe
authors.initials: A
authors.lastname: Yıldırım
authors.forename: Füsun
authors.initials: F
authors.lastname: Güzelmeriç
authors.forename: C Naci
authors.initials: CN
authors.lastname: Öner
authors.forename: Aysu Türkmen
authors.initials: AT
authors.lastname: Karaağaç
authors.forename: Ahmet
authors.initials: A
authors.lastname: Şaşmazel
authors.forename: Hasan
authors.initials: H
authors.lastname: Erdem
authors.forename: Osman
authors.initials: O
authors.lastname: Özdemir
authors.forename: Ayşe
authors.initials: A
authors.lastname: Baysal
mesh_terms: D015415:Biomarkers / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood / Q000601:surgery*; D007223:Infant; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood*
chemical_list: D015415:Biomarkers; D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1