title: Perioperative Brain Natriuretic Peptide in Pediatric Cardiac Surgery Patients: Its Association With Postoperative Outcomes.
abstract: OBJECTIVE
  The aim of this study was to investigate the relationship between perioperative brain natriuretic peptide levels and the incidence of postoperative serious adverse events (SAEs) in pediatric cardiac patients.
  
  
  METHODS
  A prospective observational study.
  
  
  METHODS
  A single-institution university hospital.
  
  
  METHODS
  Children under 15 years old who underwent cardiac surgery that required cardiopulmonary bypass from December 21, 2012 to February 26, 2014. The Risk Adjustment for Congenital Heart Surgery 1 category less than 1 was excluded.
  
  
  METHODS
  Brain natriuretic peptide (BNP) levels were measured preoperatively (BNPpre) and on postoperative day 1 (BNPPOD1) and postoperative day 3 (BNPPOD3).
  
  
  RESULTS
  Primary outcome was the incidence of postoperative SAEs; (1) death in the intensive care unit, (2) requirement of extracorporeal membrane oxygenation, (3) cardiac arrest, and (4) requirement of reoperation for hemodynamic instability. The authors included 71 patients in this study. There were 8 patients (11%) who had at least 1 SAE. Median preoperative BNP level in patients with SAEs was significantly higher than in those without SAEs (1,541 pg/mL [IQR: 121-5,962] v 122 pg/mL [QR: 34-342], p = 0.01). From the receiver operating characteristic curve of BNPprefor the incidence of SAEs, an area under the curve was 0.77 (95%CI 0.55-0.91). The best cutoff BNPprenumber was 1,000 pg/mL. From the multivariate logistic regression model, BNPpre>1,000 pg/mL was associated independently with risk of SAEs (adjusted odds ratio = 8.5, 95% CI [1.3, 59.3], p = 0.02).
  
  
  CONCLUSIONS
  In conclusion, the authors' study showed that increased preoperative brain natriuretic peptide concentration, especially a concentration of more than 1,000 pg/mL, was associated with risk of SAEs in pediatric cardiac surgery patients.
authors.affiliation: Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Okayama, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Kanazawa
authors.affiliation: Department of Anesthesiology, Kobe University Hospital, Kobe, Hyogo, Japan.
authors.forename: Moritoki
authors.initials: M
authors.lastname: Egi
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Kawasaki Medical School, Okayama, Okayama, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Toda
authors.affiliation: Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Okayama, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Shimizu
authors.affiliation: Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Okayama, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sugimoto
authors.affiliation: Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Okayama, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Iwasaki
authors.affiliation: Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Okayama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Morimatsu
mesh_terms: D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000639:trends; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000097:blood* / Q000175:diagnosis; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: brain natriuretic peptide; pediatric cardiac surgery patients; serious adverse events