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Kumar A, Aggarwal M, Mohapatra A, Ameta N. Association of Neutrophil-Lymphocyte Ratio and Red Blood Cell Distribution Width with Poor Outcome in Pediatric Cardiac Surgery - A Retrospective Observational Study. Ann Card Anaesth 2024; 27:213-219. [PMID: 38963355 DOI: 10.4103/aca.aca_9_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/17/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Neutrophil-lymphocyte ratio (NLR) is a valuable indicator for evaluating inflammatory response and red blood cell distribution width (RBDW), a routinely available biomarker of likely erythropoietic dysfunction, which may be associated with adverse outcomes after cardiac surgery. This study aimed to investigate the association between these two readily available haematological parameters, with the poor outcomes in paediatric patients undergoing cardiac surgery. METHODS A comprehensive review of medical records for paediatric patients who underwent cardiac surgery at our tertiary care centre between April 2022 and June 2023 was carried out. RBDW and NLR values were collected from complete blood count reports obtained on admission to the ICU. Demographic data, surgical details, and postoperative complications were also recorded. A receiver operating characteristic (ROC) curve and multivariable logistic regression were applied to identify the prognosis performance of preoperative NLR and RBDW for poor outcomes. RESULTS The study included 219 patients meeting the inclusion criteria of which a total of 90 (41%) children experienced at least one of the poor outcomes. Preoperative NLR (AUC=0.88, 95%CI 0.36-0.70, cut off- 4.2) and RBDW (AUC=0.88, 95%CI 0.39-0.73, cut off- 18.5%) showed prognostic significance in the perioperative period. CONCLUSION This retrospective observational study highlights a significant association between elevated Red Blood Cell Distribution Width (RBDW) and Neutrophil Lymphocyte Ratio (NLR) values and poor outcomes in paediatric patients undergoing cardiac surgery. These readily available haematological parameters could serve as potential prognostic indicators for identifying patients at risk of poor outcomes.
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Affiliation(s)
- Alok Kumar
- Department of Anaesthesia and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Monika Aggarwal
- Department of Lab Sciences, Armed Forces Medical College, Pune, Maharashtra, India
| | - Akash Mohapatra
- Department of Anaesthesia and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Nihar Ameta
- Department of Anaesthesia and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
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Qin X, Dan Y, Wang H, Sun L, Ji W, Bai J, Mamtili I, Zhang K, Zheng J. Effect of Ciprofol on Left Ventricular Myocardial Strain and Myocardial Work in Children Undergoing Cardiac Surgery: A Single-center Double-blind Randomized Noninferiority Study. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00370-7. [PMID: 38908938 DOI: 10.1053/j.jvca.2024.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/12/2024] [Accepted: 05/29/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE The current work was designed to compare the effects of ciprofol and propofol on left ventricular systolic function and myocardial work by noninvasive speckle-tracking echocardiography in children undergoing surgical repair of atrial septal or ventricular septal defects. DESIGN A single-center double-blind randomized noninferiority study was conducted. SETTING The research occurred at a tertiary care center affiliated with Shanghai Jiao Tong University, China. PARTICIPANTS One hundred and twelve children aged 1 month to 16 years undergoing atrial septal or ventricular septal defect surgery with cardiopulmonary bypass were included. INTERVENTIONS One hundred and twelve children were allocated randomly to receive ciprofol (n = 67) or propofol (n = 45) in a 1.5:1 ratio. Ciprofol or propofol were intravenously infused at loading doses of 0.4 mg/kg or 2.0 mg/kg, respectively, over 30 seconds, depending on the physical condition of each patient. When the bispectral index was maintained between 45 and 55 after induction, transthoracic echocardiography, including apical two-chamber, three-chamber, and four-chamber views, were collected bedside. MEASUREMENTS AND MAIN RESULTS Of the 112 patients enrolled, 104 completed the study. Global longitudinal strain in the ciprofol and propofol groups after anesthesia was -17.3% (95% confidence interval [CI] -18.0% to -16.6%) and -17.8% (95% CI -18.7 to -17.0%) in the full analysis set and -17.5% (95% CI -18.2% to -16.9%) and -17.8% (95% CI -18.7% to -17.0%) in the per-protocol set, respectively. The noninferiority margin was set at 2% and confirmed with a lower limit of two-sided 95% CI for the intergroup difference of 1.58% in the full analysis set and 1.34% in the per-protocol set. There were no significant differences between the groups in left ventricular systolic and diastolic function and myocardial work indices. Postoperative vasoactive-inotropic score, NT-proBNP, duration of mechanical ventilation, and the length of stay in the cardiac intensive care unit and hospital were also comparable between the two groups (all p > 0.05). CONCLUSIONS Ciprofol did not show different effects on myocardial function and postoperative outcomes from propofol. Further, on the sensitive cardiac systole marker global longitudinal strain, ciprofol demonstrated noninferiority to propofol. Ciprofol might be an alternative solution for cardiac anesthesia in children with congestive heart disease with mild lesion.
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Affiliation(s)
- Xiaoxue Qin
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China; Department of Anesthesiology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Yingzhi Dan
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China
| | | | - Liping Sun
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China
| | - Wei Ji
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China
| | - Jie Bai
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China; Department of Anesthesiology, Shanghai Children's Medical Center Hainan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ilyar Mamtili
- Department of Anesthesiology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Kan Zhang
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China; Department of Anesthesiology, Shanghai Children's Medical Center Hainan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jijian Zheng
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Anesthesiology, National Children's Medical Center, Shanghai, China.
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Shen H, He Q, Shao X, Lin YH, Wu D, Ma K, Dou Z, Liu Y, Luo F, Li S, Zhou Z. Predictive value of NT-proBNP and hs-TnT for outcomes after pediatric congenital cardiac surgery. Int J Surg 2024; 110:3365-3372. [PMID: 38498395 PMCID: PMC11175761 DOI: 10.1097/js9.0000000000001311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/25/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND The available evidence regarding the predictive value of troponins and natriuretic peptides for early postoperative outcomes in pediatrics is limited, controversial, and based on small sample sizes. The authors aimed to investigate the association of N-terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hs-TnT) with the in-hospital adverse outcomes after congenital cardiac surgeries. METHODS A secondary analysis based on a prospective study of pediatric congenital heart disease (CHD) patients was conducted to investigate the association of NT-proBNP and hs-TnT tested within 6 h postoperatively with in-hospital adverse events. A multivariate logistic regression analysis with a minimum P value approach was used to identify the optimal thresholds of NT-proBNP and hs-TnT for risk stratification. RESULTS NT-proBNP and hs-TnT are positively correlated with cardiopulmonary bypass time, mechanical ventilation duration, and pediatric intensive care unit stay. The predictive performance of NT-proBNP is excellent for adverse events in both patients younger than 1 year [area under the curve (AUC): 0.771, 0.693-0.850] and those older than 1 year (AUC: 0.839, 0.757-0.922). However, hs-TnT exhibited a satisfactory predictive value solely in patients aged over 1 year. (AUC: 0.784, 0.717-0.852). NT-proBNP levels of 2000-10 000 ng/l [odds ratio (OR): 3.79, 1.47-9.76] and exceeding 10 000 ng/l (OR: 12.21, 3.66-40.80) were associated with a higher risk of postoperative adverse events in patients younger than 1 year. Patients older than 1 year, with NT-proBNP higher than 500 ng/l (OR: 15.09, 6.05-37.66) or hs-TnT higher than 1200 ng/l (OR: 5.50, 1.47-20.59), had a higher incidence of postoperative adverse events. CONCLUSIONS NT-proBNP and hs-TnT tested within postoperative 6 h demonstrated significant predictive value for postoperative adverse events in CHD patients older than 1 year. However, among CHD patients younger than 1 year, only NT-proBNP exhibited commendable predictive performance for postoperative adverse events.
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Affiliation(s)
- Huayan Shen
- Center of Laboratory Medicine, State Key Laboratory of Cardiovascular Disease, Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases
| | - Qiyu He
- Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Xinyang Shao
- Center of Laboratory Medicine, State Key Laboratory of Cardiovascular Disease, Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases
| | - Ya-hui Lin
- Center of Laboratory Medicine, State Key Laboratory of Cardiovascular Disease, Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases
| | - Dongdong Wu
- Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Kai Ma
- Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Zheng Dou
- Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yuze Liu
- Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Fengming Luo
- Center of Laboratory Medicine, State Key Laboratory of Cardiovascular Disease, Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases
| | - Shoujun Li
- Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Zhou Zhou
- Center of Laboratory Medicine, State Key Laboratory of Cardiovascular Disease, Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases
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The use of N-terminal (1-76) pro-brain natriuretic peptide in the aetiology of severe respiratory distress in the paediatric emergency department. Cardiol Young 2022; 32:1761-1767. [PMID: 34915965 DOI: 10.1017/s104795112100490x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Acute respiratory distress is one of the most common reasons for paediatric emergency visits. Paediatric patients require rapid diagnosis and treatment. Our aim in this study was to use N-terminal (1-76) pro-brain natriuretic peptide to differentiate respiratory distress of cardiac and pulmonary origin in children. Our aim was to investigate the role of N-terminal (1-76) pro-brain natriuretic peptide in the detection of patients with new-onset heart failure in the absence of an underlying congenital heart anomaly. METHODS All children aged 0-18 years who presented to the paediatric emergency department due to severe respiratory distress were included in the study prospectively. The patients' demographic characteristics, presenting complaints, clinical findings, and N-terminal (1-76) pro-brain natriuretic peptide concentrations, were investigated. In patients with severe Pediatric Respiratory Severity Score, congestive heart failure score was calculated using the modified Ross Score. RESULTS This study included 47 children between the ages of 1 month and 14 years. The median N-terminal (1-76) pro-brain natriuretic peptide concentration was 5717 (IQR:16158) pg/mL in the 25 patients with severe respiratory distress due to heart failure and in the 22 patients with severe respiratory distress due to lung pathology was 437 (IQR:874) pg/mL (p < 0.001). In the 25 patients with severe respiratory distress due to heart failure, 8281 (IQR:8372) pg/mL in the 16 patients with underlying congenital heart anomalies, and 1983 (IQR:2150) pg/mL in the 9 patients without a congenital heart anomaly (p < 0.001). The 45 patients in the control group had a median N-terminal (1-76) pro-brain natriuretic peptide concentration of 47.2 (IQR:56.2) pg/mL. CONCLUSION Using scoring systems in combination with N-terminal (1-76) pro-brain natriuretic peptide cut-off values can help direct and manage treatment.
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Lin HC, Huang SC, Wu MH, Wang JK, Lin MT, Chen CA, Lu CW, Chen YS, Chiu SN. Preoperative N-terminal pro-brain natriuretic peptide is associated with Fontan outcomes. J Thorac Cardiovasc Surg 2022; 164:770-780.e3. [PMID: 35031137 DOI: 10.1016/j.jtcvs.2021.11.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/20/2021] [Accepted: 11/30/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The role of preoperative N-terminal pro-brain natriuretic peptide level in patient outcomes after the Fontan operation remains unclear. METHODS The medical records of all patients who underwent their first Fontan operation from June 2011 to October 2019 in our tertiary referral pediatric cardiac center were retrospectively reviewed. Preoperative hemodynamic factors and N-terminal pro-brain natriuretic peptide were analyzed to test the association of mortality and morbidity. RESULTS We enrolled 110 patients (men/women 62/48; median age, 4.1 [3.4, 5.8] years; median follow-up period, 4.28 [2.31, 6.71] years). Almost all operations were extracardiac conduits (98.2%). Primary outcomes of death, Fontan takedown, and heart transplantation were observed in 9 patients (8.2%). Abnormal ventricular contractility, elevated preoperative pulmonary artery pressure, high pulmonary vascular resistance index, and high log10 N-terminal pro-brain natriuretic peptide level were associated with poor outcomes. SECONDARY OUTCOMES atrioventricular valve regurgitation moderate or greater, elevated pulmonary artery pressure, high pulmonary vascular resistance index, and high log10 N-terminal pro-brain natriuretic peptide level were associated with rehospitalization due to heart failure. Multivariable Cox regression analysis revealed that log10 N-terminal pro-brain natriuretic peptide was the only significant predictor of all primary and secondary outcomes. A scoring system including factors of pulmonary artery pressure, pulmonary vascular resistance index, and N-terminal pro-brain natriuretic peptide was established, and the risk stratification is associated with outcomes after the Fontan operation. CONCLUSIONS High preoperative N-terminal pro-brain natriuretic peptide was associated with poor outcomes after the Fontan operation.
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Affiliation(s)
- Hsin-Chia Lin
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Shu-Chien Huang
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Yih-Sharng Chen
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.
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Mid-regional pro-adrenomedullin for diagnosing evolution after cardiac surgery in newborns: the PRONEW study. Eur J Pediatr 2022; 181:1017-1028. [PMID: 34686907 DOI: 10.1007/s00431-021-04278-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/13/2021] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
Newborns are the most vulnerable patients after cardiac surgery. Although mortality risk scores before surgery may help predict the risk of poor outcome, new tools are required, and biomarkers could add objective data to these tools. The aim of this study was to assess the ability of mid-regional pro-adrenomedullin (pro-ADM) and pro-atrial natriuretic peptide (pro-ANP) to predict poor outcome after cardiac surgery. This is a pilot diagnostic accuracy study that includes newborns and infants under 2 months admitted to an intensive care unit after cardiac surgery. Pro-ADM and pro-ANP were determined immediately upon admission. Poor outcome was defined as mortality, cardiac arrest, requiring extracorporeal support, requiring renal replacement therapy, or neurological injury. Forty-four patients were included. Twenty-six (59%) had a STAT category of ≥ 4. Ten patients (22.7%) presented a poor outcome, four of whom (9.1%) died. Pro-ADM was higher in patients with poor outcome (p = 0.024) and death (p = 0.012). Pro-ADM showed the best area under curve (AUC) for predicting poor outcome (0.735) and mortality alone (0.869). A pro-ADM of 2 nmol/L had a Sn of 75% and a Sp of 85% for predicting mortality. Pro-ADM > 2 nmol/L was independently associated with poor outcome (OR 5.8) and mortality (OR 14.1). Although higher pro-ANP values were associated with poor outcomes, no cut-off point were found. The combination of STAT ≥ 4 and the biomarkers did not enhance predictive power for poor outcome or mortality.Conclusion: Pro-ADM and pro-ANP determined immediately after surgery could be helpful for stratifying risk of poor outcome and mortality in newborns. What is Known: • Some congenital heart diseases must be corrected/palliated during the first days of life. A useful tool to predict the risk of severe complications has not been proposed. • Most unstable newborns would have higher values of biomarkers such as pro-ADM and pro-ANP related to shock and compensatory actions. What is New: • Pro-ADM and pro-ANP seem to be good biomarkers to predict poor outcome after cardiac surgery. A pro-ADM < 2 nmol/L would imply a low likelihood of a poor outcome. • Deepening the analysis of biomarkers can help in making decisions to prevent/treat complications.
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Li H, Liu J, Shi H. Effect of Dexmedetomidine on Perioperative Hemodynamics and Myocardial Protection in Thoracoscopic-Assisted Thoracic Surgery. Med Sci Monit 2021; 27:e929949. [PMID: 34341325 PMCID: PMC8348991 DOI: 10.12659/msm.929949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND This study aimed to clarify the protective role of dexmedetomidine in thoracoscopic-assisted thoracic surgery (TATS), including control of the intraoperative heart rate, blood pressure, and myocardial injury markers. MATERIAL AND METHODS The patients who underwent TATS were divided into 2 equal groups: the dexmedetomidine group (dexmedetomidine pumped at 0.5 µg/kg for >10 min before the administration of anesthesia and at 0.5 µg/kg in the maintenance period) and the control group (pumped normal saline for >10 min before the administration of anesthesia). The data recorded for each patient were heart rate (preoperative, maximum intraoperative, and minimum intraoperative), systolic and diastolic blood pressure, intraoperative hemodynamic data, and intraoperative cardiovascular drugs administered. An enzyme-linked immunosorbent assay was performed to assess the postoperative levels of cardiac troponin I (cTnI), creatine kinase isoenzyme, myoglobin, and N-terminal pro-B-type natriuretic peptide (NT-proBNP). RESULTS There were no significant differences in the age, sex, body height, body weight, American Society of Anesthesiologists classification grade, resection mode, operation time, ejection fraction, basal heart rate, and systolic and diastolic blood pressure of the 2 groups. In the dexmedetomidine group, the patients' maximum intraoperative heart rate and diastolic pressure decreased, and the postoperative hospital stay period was shorter. The postoperative peripheral blood test for the dexmedetomidine group showed higher NT-proBNP levels and lower cTnI levels. CONCLUSIONS Preoperative administration of dexmedetomidine can benefit hemodynamic stability, protect the cardiovascular system in the intraoperative and postoperative periods, and shorten postoperative hospitalization.
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Affiliation(s)
- Hua Li
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Shanghai, China (mainland)
| | - Ji Liu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Shanghai, China (mainland)
| | - Hong Shi
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Shanghai, China (mainland)
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Yin X, Xin M, Ding S, Gao F, Wu F, Wang J, Chen J, Jiang L, Wu X, Wang X, Liu J, Zhang J, He S. Predictive role of perioperative neutrophil to lymphocyte ratio in pediatric congenital heart disease associated with pulmonary arterial hypertension. BMC Surg 2021; 21:3. [PMID: 33397333 PMCID: PMC7780205 DOI: 10.1186/s12893-020-01009-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/13/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND We aimed to explore the relationship between the neutrophil to lymphocyte ratio (NLR) and the early clinical outcomes in children with congenital heart disease (CHD) associated with pulmonary arterial hypertension (PAH) after cardiac surgery. METHODS A retrospective observational study involving 190 children from January 2013 to August 2019 was conducted. Perioperative clinical and biochemical data were collected. RESULTS We found that pre-operative NLR was significantly correlated with AST, STB, CR and UA (P < 0.05), while post-operative NLR was significantly correlated with ALT, AST, BUN (P < 0.05). Increased post-operative neutrophil count and NLR as well as decreased lymphocyte count could be observed after cardiac surgery (P < 0.05). Level of pre-operative NLR was significantly correlated with mechanical ventilation time, ICU stay time and total length of stay (P < 0.05), while level of post-operative NLR was only significantly correlated to the first two (P < 0.05). By using ROC curve analysis, relevant areas under the curve for predicting prolonged mechanical ventilation time beyond 24 h, 48 h and 72 h by NLR were statistically significant (P < 0.05). CONCLUSION For patients with CHD-PAH, NLR was closely related to early post-operative complications and clinical outcomes, and could act as a novel marker to predict the occurrence of prolonged mechanical ventilation.
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Affiliation(s)
- Xiaoqiang Yin
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Mei Xin
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Sheng Ding
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Feng Gao
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Fan Wu
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Jian Wang
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Jie Chen
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Li Jiang
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Xiaochen Wu
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Xianying Wang
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jingzhen Liu
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Jinbao Zhang
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China.
- North Sichuan Medical College, Nanchong, Sichuan, China.
| | - Siyi He
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China.
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Zheng H, Cui Y, Li K, Zhang J, Qu J, Shi H, Li L, Xia H, Chen X, Liang H. The association between the pattern of change in N-terminal pro-B-type natriuretic peptide and short-term outcomes in children undergoing surgery for congenital heart disease. Interact Cardiovasc Thorac Surg 2020; 32:601-606. [PMID: 33313833 DOI: 10.1093/icvts/ivaa310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/19/2020] [Accepted: 10/31/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study aimed to determine whether changes in perioperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) are associated with short-term outcomes in children undergoing surgery for congenital heart disease (CHD). METHODS We retrospectively included 873 consecutive children with CHD after cardiac surgery. NT-proBNP concentrations were collected from each child prior to and at 1, 12, 36 and 72 h after surgery. The patients had postsurgical follow-ups at 30, 90 and 180 days. The end point was postoperative composite adverse events. RESULTS The patients were classified into 3 groups using joint latent class mixture time-to-event models: (i) relatively stable (86.7%), (ii) decreasing (7.2%) and (iii) increasing (6.1%). In total, 257 (29.4%) adverse events occurred. The joint latent class mixture time-to-event models showed that increasing NT-proBNP was strongly associated with adverse events, with adjusted hazard ratio of 2.33 (95% confidence interval 1.52-3.60). Multinomial logistic regression showed that the variables associated with the pattern of change were age, weight at surgery, mode of delivery and cardiopulmonary bypass time. CONCLUSIONS The pattern of dynamic postsurgical changes in NT-proBNP may facilitate outcome stratification and identification of a high risk for adverse events.
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Affiliation(s)
- Haiqing Zheng
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yanqin Cui
- Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Kuanrong Li
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jiexin Zhang
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jiangbo Qu
- Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hui Shi
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - LiJuan Li
- Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huimin Xia
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xinxin Chen
- Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huiying Liang
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Mori Y, Nakashima Y, Kaneko S, Inoue N, Murakami T. Risk Factors for Cardiac Adverse Events in Infants and Children with Complex Heart Disease Scheduled for Bi-ventricular Repair: Prognostic Value of Pre-operative B-Type Natriuretic Peptide and High-Sensitivity Troponin T. Pediatr Cardiol 2020; 41:1756-1765. [PMID: 32808054 DOI: 10.1007/s00246-020-02437-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/07/2020] [Indexed: 11/26/2022]
Abstract
Few reports have described the prognostic value of measuring both B-type natriuretic peptides (BNP) and high-sensitivity troponin T (hs-TnT) in pediatric patients with complex congenital heart disease (CHD) undergoing surgery. We assessed demographic, hemodynamic, and laboratory data, including BNP and hs-TnT levels, for the prediction of cardiac adverse events in 85 patients. Cardiac adverse events were defined as death, cardiac arrest, worsening heart failure requiring inotropic agents and/or respiratory support, and unscheduled surgery/intervention either within or after 12 months of surgery. There were 17 cardiac adverse events. Of the demographic variables, low birth weight (< 2500 g: Odds ratio [OR], 5.97; 95% confidential interval [CI] 1.48-24.0; p = 0.001) and Ross/New York Heart Association [NYHA] class (≥ 2.0) (OR 12.7; 95% CI 3.08-52.7; p = 0.0004) were strongly association with cardiac adverse events. Among hemodynamic and laboratory variables, preoperative BNP (OR 14.04; 95% CI 2.15-91.7; p = 0.001) and hs-TnT levels (OR 16.66; 95% CI 2.27-122; p = 0.002) were found to be independent risk factors. Receiver operating characteristic analysis determined BNP and hs-TnT levels of 60.9 pg/mL and 0.025 ng/mL, respectively, to be markers of high risk. Kaplan-Meier analysis demonstrated significant differences in the freedom from cardiac adverse events between Group A (BNP or hs-TnT elevated, n = 26) and Group B (both biomarkers elevated, n = 19; log-rank, p < 0.001). In conclusion, low birth weight (< 2500 g) and Ross/NYHA class ≥ 2.0 are strongly associated with cardiac adverse events. Preoperative BNP and hs-TnT also provide prognostic information in patients with complex CHD scheduled for surgery. Using both markers in combination predicts cardiac adverse events better than using either separately.
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Affiliation(s)
- Yoshiki Mori
- Division of Pediatric Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan.
| | - Yasumi Nakashima
- Division of Pediatric Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Sachie Kaneko
- Division of Pediatric Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Nao Inoue
- Division of Pediatric Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Tomotaka Murakami
- Division of Pediatric Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
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Pro-atrial natriuretic peptide and pro-adrenomedullin before cardiac surgery in children. Can we predict the future? PLoS One 2020; 15:e0236377. [PMID: 32702064 PMCID: PMC7377469 DOI: 10.1371/journal.pone.0236377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/02/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Pro-atrial natriuretic peptide (proANP) and pro-adrenomedullin (proADM) levels increase in acute heart failure and sepsis. After cardiac surgery, children may require increased support in the intensive care unit and may develop complications. The aim of this study was to evaluate the utility of proANP and proADM values, determined prior to cardiac surgery, for predicting the need for increased respiratory or inotropic support during the post-operative period. METHODS This was a prospective study in children. Biomarkers were analyzed before surgery using a single blood test. The primary endpoints were the need for greater respiratory and/or inotropic support during the post-operative period. Secondary endpoints were the relationship between these biomarkers and complications after surgery. RESULTS One hundred thirteen patients were included. ProANP and proADM were higher in children who required greater respiratory and inotropic support, especially proANP; for increased respiratory support, 578.9 vs. 106.6 pmol/L (p = 0.004), and for increased inotropic support, 1938 vs. 110.4 pmol/L (p = 0.002). ProANP had a greater AUC than proADM for predicting increased respiratory support after surgery: 0.791 vs. 0.724. A possible cut-off point for proANP could be ≥ 325 pmol/L (sensitivity = 66.7% and specificity = 88.8%). In the multivariate analysis, the logarithmic transformation of proANP was independently associated with the need for increased respiratory support (OR = 3.575). Patients who presented a poor outcome after cardiac surgery also had higher biomarker values (proADM, p = 0.013; proANP, p = 0.001). CONCLUSIONS Elevated proANP before cardiac surgery may identify which children will need more respiratory and inotropic support during the post-operative period.
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Houska NM, Schwartz LI. The Year in Review: Anesthesia for Congenital Heart Disease 2019. Semin Cardiothorac Vasc Anesth 2020; 24:175-186. [DOI: 10.1177/1089253220920476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This review focuses on the literature published from January 2019 to February 2020 that is of interest to anesthesiologists taking care of children and adults with congenital heart disease. Five themes are addressed during this time period, and 59 peer-reviewed articles are discussed.
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Affiliation(s)
- Nicholas M. Houska
- Children’s Hospital Colorado, Aurora, CO, USA
- University of Colorado, Aurora, CO, USA
| | - Lawrence I. Schwartz
- Children’s Hospital Colorado, Aurora, CO, USA
- University of Colorado, Aurora, CO, USA
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Du X, Chen H, Song X, Wang S, Hao Z, Yin L, Lu Z. Risk factors for low cardiac output syndrome in children with congenital heart disease undergoing cardiac surgery: a retrospective cohort study. BMC Pediatr 2020; 20:87. [PMID: 32093619 PMCID: PMC7038550 DOI: 10.1186/s12887-020-1972-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 02/11/2020] [Indexed: 11/20/2022] Open
Abstract
Background Low cardiac output syndrome (LCOS) is an important complication of cardiac surgery. It is associated with increased morbidity and mortality. The incidence of LCOS after surgery is high in patients with congenital heart disease (CHD). Therefore, determining the risk factors of LCOS has clinical significance for the management of CHD. This study aimed to analyze the risk factors of LCOS. Methods We conducted a retrospective analysis of children with CHD who underwent cardiac surgery at Shanghai Children’s Medical Center between January 1, 2014, and December 31, 2017. Demographic characteristics and baseline data were extracted from the health data resource center of the hospital, which integrates clinical routine data including medical records, diagnoses, orders, surgeries, laboratory tests, imaging, nursing, and other subsystems. Logistic regressions were performed to analyze the risk factors of LCOS. Results Overall, 8660 infants with CHD were included, and 864 (9.98%) had LCOS after surgery. The multivariate regression analysis identified that age (OR 0.992, 95% CI: 0.988–0.997, p = 0.001), tricuspid regurgitation (1.192, 1.072–1.326, p = 0.001), Risk Adjustment in Congenital Heart Surgery-1 risk grade (1.166, 1.011–1.345, p = 0.035), aortic shunt (left-to-right: 1.37, 1.005–1.867, p = 0.046; bi-directional: 1.716, 1.138–2.587, p = 0.01), atrial shunt (left-to-right: 1.407, 1.097–1.805, p = 0.007; right-to-left: 3.168, 1.944–5.163, p < 0.001; bi-directional: 1.87, 1.389–2.519, p < 0.001), ventricular level shunt (left-to-right: 0.676, 0.486–0.94, p = 0.02; bi-directional: 2.09, 1.611–2.712, p < 0.001), residual shunt (3.489, 1.502–8.105, p = 0.004), left ventricular outflow tract obstruction (3.934, 1.673–9.254, p = 0.002), right ventricular outflow tract obstruction (3.638, 1.225–10.798, p = 0.02), circulating temperature (mild hypothermia: 1.526, 95% CI: 1.205–1.934, p < 0.001; middle and low temperature: 1.738, 1.236–2.443, p = 0.001), duration of cardiopulmonary bypass (1.009, 1.006–1.012, p < 0.001), myocardial preservation using histidine-tryptophan-ketoglutarate (1.677, 1.298–2.167, p < 0.001), and mitral insufficiency (1.714, 1.239–2.37, p < 0.001) were independent risk predictors of LCOS. Conclusions The incidence of postoperative LCOS in CHD children remains high. Circulation temperature, myocardial preservation using histidine-tryptophan-ketoglutarate, and usage of residual shunt after surgery were independent risk predictors for LCOS.
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Affiliation(s)
- Xinwei Du
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong district, Shanghai, China
| | - Hao Chen
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong district, Shanghai, China
| | - Xiaoqi Song
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong district, Shanghai, China
| | - Shunmin Wang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong district, Shanghai, China
| | - Zedong Hao
- Synyi Medical Technology, Shanghai, China
| | - Lifeng Yin
- Synyi Medical Technology, Shanghai, China
| | - Zhaohui Lu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong district, Shanghai, China.
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Lin F, Zheng L, Cui Y, Chen W, Gupta RK, Li H, Chen X, Xia H, Liang H. Prognostic value of perioperative NT-proBNP after corrective surgery for pediatric congenital heart defects. BMC Pediatr 2019; 19:497. [PMID: 31842815 PMCID: PMC6913023 DOI: 10.1186/s12887-019-1830-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/11/2019] [Indexed: 11/18/2022] Open
Abstract
Background It is critically important to assess the prognostic value of NT-proBNP in the form of repeated measures among children undergoing surgery for congenital heart defects (CHD). The aim of the present study is to assess the value of repeated perioperative NT-proBNP in evaluating the time dependent and temporal trajectory in prognostics diagnosis during the perioperative period in a large series of children with CHD. Methods Repeated measures of NT-proBNP from 329 consecutive children with CHD were obtained before and 1, 12, and 36 h after surgery, respectively. For fully utilizing longitudinal characteristics, we employed parallel cross-sectional logistic regression, a two stage mixed effect model and trajectories over time analysis to mine the predictive value of perioperative NT-proBNP on the binary outcome of prolonged intensive care unit (ICU) stay. Results The two stage mixed effects model confirmed that both the mean NT-proBNP level (aOR = 1.46, P = 0.001) and the time trends had prognostic value on the prediction of prolonged ICU stay. In the fully adjusted logistic regression analyses based on gaussian distributions, “rapidly rising NT-proBNP” put the subjects at 5.4-times higher risk of prolonged ICU stay compared with “slowly rising” group (aOR = 5.40, P = 0.003). Conclusions Comprehensive assessment of the time dependent and temporal trajectory in perioperative NT-proBNP, indicated by repeated measurements, can provide more accurate identification of children with higher risk of prolonged ICU stay after CHD surgery.
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Affiliation(s)
- Fangqin Lin
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Lingling Zheng
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yanqin Cui
- Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Weidan Chen
- Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ramit Kumar Gupta
- Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huixian Li
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xinxin Chen
- Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huimin Xia
- Department of Pediateric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huiying Liang
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
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Pérez-Navero J, Merino-Cejas C, Ibarra de la Rosa I, Jaraba-Caballero S, Frias-Perez M, Gómez-Guzmán E, Gil-Campos M, de la Torre-Aguilar M. Evaluation of the vasoactive-inotropic score, mid-regional pro-adrenomedullin and cardiac troponin I as predictors of low cardiac output syndrome in children after congenital heart disease surgery. Med Intensiva 2019; 43:329-336. [DOI: 10.1016/j.medin.2018.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 04/19/2018] [Accepted: 04/24/2018] [Indexed: 10/14/2022]
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Bobillo-Perez S, Jordan I, Corniero P, Balaguer M, Sole-Ribalta A, Esteban ME, Esteban E, Cambra FJ. Prognostic value of biomarkers after cardiopulmonary bypass in pediatrics: The prospective PANCAP study. PLoS One 2019; 14:e0215690. [PMID: 31206538 PMCID: PMC6576774 DOI: 10.1371/journal.pone.0215690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/05/2019] [Indexed: 01/03/2023] Open
Abstract
Objective To assess the usefulness of procalcitonin, pro-adrenomedullin and pro-atrial natriuretic peptide as predictors of need for mechanical ventilation and postoperative complications (need for inotropic support and bacterial infection) in critically ill pediatric patients after cardiopulmonary bypass. Design A prospective, observational study Setting Pediatric intensive care unit. Patients Patients under 18 years old admitted after cardiopulmonary bypass. Measuraments and main results Serum levels of procalcitonin, pro-adrenomedullin and pro-atrial natriuretic peptide were determined immediately after bypass and at 24–36 hours. Their values were correlated with the need for mechanical ventilation, inotropic support and bacterial infection. One hundred eleven patients were recruited. Septal defects (30.6%) and cardiac valve disease (17.1%) were the most frequent pathologies. 40.7% required mechanical ventilation, 94.6% inotropic support and 15.3% presented invasive bacterial infections. Pro-adrenomedullin and pro-atrial natriuretic peptide showed significant high values in patients needing mechanical ventilation. Cut-off values higher than 1.22 nmol/L and 215.3 pmol/L, respectively for each biomarker, may indicate need for mechanical ventilation with an AUC of 0.721 and 0.746 at admission and 0.738 and 0.753 at 24–36 hours, respectively but without statistical differences. Pro-adrenomedullin and procalcitonin showed statistically significant high values in patients with bacterial infections. Conclusions After bypass, pro-adrenomedullin and pro-atrial natriuretic peptide are suitable biomarkers to predict the need for mechanical ventilation. Physicians should be alert if the values of these markers are high so as not to progress to early extubation. Procalcitonin is useful for predicting bacterial infection. This is a preliminary study and more clinical studies should be done to confirm the value of pro-adrenomedullin and pro-atrial natriuretic peptide as biomarkers after cardiopulmonary bypass.
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Affiliation(s)
- Sara Bobillo-Perez
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Pediatric Intensive Care Research Group, Institut Recerca Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Iolanda Jordan
- Pediatric Intensive Care Unit, Sant Joan de Déu Hospital, Pediatric Intensive Care Research Group, Institut Recerca Hospital Sant Joan de Déu, CIBERESP, Barcelona, Spain
- * E-mail:
| | - Patricia Corniero
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Monica Balaguer
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Anna Sole-Ribalta
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Maria Esther Esteban
- Section of Zoology and Biological Anthropology, Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, Universitat de Barcelona, Barcelona, Spain
- Institut de Recerca de la Biodiversitat (IRBio), Universitat de Barcelona, Barcelona, Spain
| | - Elisabeth Esteban
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain
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Change in N-terminal pro B-type natriuretic peptide levels and clinical outcomes in children undergoing congenital heart surgery. Int J Cardiol 2019; 283:96-100. [DOI: 10.1016/j.ijcard.2019.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/31/2019] [Accepted: 02/13/2019] [Indexed: 11/20/2022]
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Zheng H, Li L, Liang H, Qu J, Li J, Cui Y, Chen X. Normalization of N-Terminal Pro-B-Type Natriuretic Peptide After Cardiac Surgery Among Children With Tetralogy of Fallot. Am J Cardiol 2018; 122:2125-2130. [PMID: 30293655 DOI: 10.1016/j.amjcard.2018.08.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/21/2018] [Accepted: 08/24/2018] [Indexed: 12/01/2022]
Abstract
The aim of this study was to temporally measure N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels over a period of 18 months after corrective surgery among children with tetralogy of Fallot (TOF) and to explore how commonly used pharmaceuticals (i.e., spironolactone and digoxin) might affect the normalization pattern. This retrospective study included 136 children with a median age of 7 months who underwent cardiac surgery for TOF. NT-proBNP level was measured at 1, 3, 6, 12, and 18 months after the surgery. Normalization of NT-proBNP was defined as an NT-proBNP level ≤250 pg/ml. The commonly used pharmaceuticals spironolactone and digoxin after discharge were collected. The normalization pattern, normalization time, and potential influence of the pharmaceuticals were determined. The rate of normalization was 24.2% (95% confidence interval [CI] 8.58% to 68.4%) per 100 person-days. Kaplan-Meier survival analysis showed a median normalization time of 517 (95% CI 429.6 to 604.3) days. The children whose NT-proBNP level did not normalize had a significantly higher readmission rate than those whose NT-proBNP level normalized (19.0% vs 2.8%, p = 0.018). Multivariable logistic regression models confirmed that the regular users of spironolactone, alone (odds ratio = 1.45, 95% CI 1.15 to 1.83) or in combination with digoxin (odds ratio = 1.28, 95% CI 1.03 to 1.58), had markedly faster recovery trajectories for measures of NT-proBNP than the irregular users of both. In conclusion, NT-proBNP normalization after cardiac surgery for TOF is a lengthy process, and irregular use of spironolactone could lead to failure in recovery and hospital readmission.
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Affiliation(s)
- Haiqing Zheng
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Lijuan Li
- The Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huiying Liang
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jiangbo Qu
- The Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jianbin Li
- The Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yanqin Cui
- The Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
| | - Xinxin Chen
- The Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
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Krichevskiy LA, Kozlov IA. Natriuretic Peptides in Cardiac Anesthesia and Intensive Care. J Cardiothorac Vasc Anesth 2018; 33:1407-1419. [PMID: 30228053 DOI: 10.1053/j.jvca.2018.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Indexed: 01/16/2023]
Abstract
Natriuretic peptides, predominantly B-type, are widely used in cardiology as prognostic and diagnostic biomarkers or, much less often, as a substantive treatment tool. They are hormones that are produced mainly in the myocardium in response to overload and ischemia, and their level quite accurately reflects the degree of myocardial dysfunction. Although their use in cardiac anesthesia and intensive care setting seems to be very beneficial for assessing the risk of acute disturbance of myocardial function or its laboratory monitoring, the actual significance of natriuretic peptides in this area is not yet recognized. This is due to the lack of clear diagnostic and prognostic values for these biomarkers supported by high-quality researches. On the basis of the available data, main advantages, existing difficulties, and most effective ways of using natriuretic peptides for determining the risk of heart surgery and assessing the severity of sepsis, pneumonia, and other critical conditions have been discussed in this review. In addition, the expediency of using natriuretic peptides as target parameters for goal-oriented therapy and as a substantive tool for treatment is considered.
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Affiliation(s)
- Lev A Krichevskiy
- Department of Anesthesiology and Intensive Care, City Clinical Hospital n.a. S.S.Yudin, Department of Health of Moscow, Moscow, Russia.
| | - Igor A Kozlov
- Department of Anaesthesiology, Moscow Regional Research Clinical Institute n.a. M.F. Vladimirskiy, Moscow, Russia
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Cui Y, Qu J, Liang H, Li Z. Relationship between perioperative N-terminal pro-brain natriuretic peptide and maximum inotropic score in children after cardiac surgery. J Thorac Cardiovasc Surg 2018; 155:2619-2621. [DOI: 10.1016/j.jtcvs.2018.02.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 02/28/2018] [Indexed: 11/24/2022]
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21
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Cantinotti M, Clerico A. The prognostic role of natriuretic peptides in children undergoing cardiac surgery: Can acute kidney injury affect their accuracy? J Thorac Cardiovasc Surg 2018; 155:2617-2618. [DOI: 10.1016/j.jtcvs.2018.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 02/05/2018] [Indexed: 12/01/2022]
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22
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Monaghan A, Corno AF. Potential usefulness of N-terminal pro–brain natriuretic peptide level in congenital heart surgery. J Thorac Cardiovasc Surg 2018; 155:2617. [DOI: 10.1016/j.jtcvs.2018.01.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/13/2018] [Indexed: 02/05/2023]
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Cantinotti M, Clerico A. Brain natriuretic peptide and N-terminal pro-brain natriuretic peptide confirmed the prognostic accuracy in pediatric cardiac surgery: Time for their inclusion in prediction risk models? J Thorac Cardiovasc Surg 2017; 154:641-643. [PMID: 28433357 DOI: 10.1016/j.jtcvs.2017.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 02/28/2017] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, Massa, Italy; Institute of Clinical Physiology, Pisa, Italy.
| | - Aldo Clerico
- Fondazione G. Monasterio CNR-Regione Toscana, Massa, Italy; St'Anna University, Pisa, Italy
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