title: Circulating histones for predicting prognosis after cardiac surgery: a prospective study.
abstract: The objective of this study was to assess the perioperative changes in circulating histones and their relationships with other biomarkers and clinical outcomes after cardiac surgery with cardiopulmonary bypass (CPB) in patients.
  
  
  
  Forty-eight patients with congenital cardiac diseases undergoing corrective procedure with CPB were prospectively enrolled in this study. Circulating histones, N-terminal pro-brain natriuretic peptide (NT-proBNP), procalcitonin (PCT) and C-reactive protein (CRP) were measured preoperatively (T0) and at 0 (T1), 24 (T2), 48 (T3) and 72 (T4) h postoperatively. The relationships between biomarkers and clinical outcomes were analysed.
  
  
  
  Circulating histones, NT-proBNP, PCT and CRP increased significantly postoperatively, with histones reaching the peak value earliest at T1. Circulating histone levels were higher in patients with adverse events. Receiver operating characteristic curve analysis showed that peak histone levels had a better predictive value for adverse events postoperatively. Peak histone levels correlated with the peak level of NT-proBNP (r = 0.563, P < 0.01), PCT (r = 0.551, P < 0.01), CRP (r = 0.606, P < 0.01) and clinical parameters such as ventilation time (r = 0.601, P < 0.01) and intensive care unit time (r = 0.623, P < 0.01).
  
  
  
  Circulating histones reached peak levels faster than NT-proBNP, PCT and CRP. Furthermore, peak histone levels correlated with biomarkers and postoperative clinical outcomes. Circulating histones may be used as a prognostic indicator for patients after cardiac surgery with CPB.
  
  
  
  ClinicalTrials.gov (ID: NCT02325765).
authors.affiliation: Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Hongxiang
authors.initials: H
authors.lastname: Gao
authors.affiliation: Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Naipu
authors.initials: N
authors.lastname: Zhang
authors.affiliation: Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Fangfang
authors.initials: F
authors.lastname: Lu
authors.affiliation: Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Xindi
authors.initials: X
authors.lastname: Yu
authors.affiliation: Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Limin
authors.initials: L
authors.lastname: Zhu
authors.affiliation: Institute for Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Xi
authors.initials: X
authors.lastname: Mo
authors.affiliation: Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China wangwei@scmc.com.cn.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
mesh_terms: D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood* / Q000601:surgery*; D006657:Histones / Q000097:blood*; D006801:Humans; D007223:Infant; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve
chemical_list: D015415:Biomarkers; D006657:Histones; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002116:Calcitonin; D002097:C-Reactive Protein
keywords: Circulating histones; Complications; Congenital heart disease; Perioperative care; Surgery