1
|
Griffiths M, Simpson CE, Yang J, Vaidya D, Nies MK, Brandal S, Damico R, Hassoun P, Ivy DD, Austin ED, Pauciulo MW, Lutz KA, Martin LJ, Rosenzweig EB, Benza RL, Nichols WC, Manlhiot C, Everett AD. Multiple Biomarkers Are Equivalent to Clinical Pulmonary Arterial Hypertension Survival Risk Models. Chest 2024:S0012-3692(24)04926-2. [PMID: 39154795 DOI: 10.1016/j.chest.2024.06.3824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND Risk assessment in pulmonary arterial hypertension (PAH) is fundamental to guiding treatment and improved outcomes. Clinical models are excellent at identifying high-risk patients, but leave uncertainty amongst moderate-risk patients. RESEARCH QUESTION Can a multiple blood biomarker model of PAH, using previously described biomarkers, improve risk discrimination over current models? STUDY DESIGN AND METHODS Using a multiplex enzyme-linked immunosorbent assay, we measured N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP), soluble suppressor of tumorigenicity, IL-6, endostatin, galectin 3, HDGF, and insulin-like growth factor binding proteins (IGFBP1-7) in training (n = 1,623), test (n = 696), and validation (n = 237) cohorts. Clinical variables and biomarkers were evaluated by principal component analysis. NT-proBNP was not included to develop a model independent of NT-proBNP. Unsupervised k-means clustering classified participants into clusters. Transplant-free survival by cluster was examined using Kaplan-Meier and Cox proportional hazard regressions. Hazard by cluster was compared with NT-proBNP, Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL), and European Society of Cardiology (ESC) and European Respiratory Society (ERS) risk models alone and combined clinical and biomarker models. RESULTS The algorithm generated 5 clusters with good risk discrimination using 6 biomarkers, weight, height, and age at PAH diagnosis. In the test and validation cohorts, the biomarker model alone performed equivalent to REVEAL (area under the receiver operating characteristic curve, 0.74). Adding the biomarker model to the ESC and ERS score and REVEAL score improved the ESC and ERS score and REVEAL score. The best overall model was the biomarker model adjusted for NT-proBNP with the best C statistic, Akaike information criterion, and calibration for the adjusted model compared with either the biomarker or NT-proBNP model alone. INTERPRETATION A multibiomarker model alone was equivalent to current PAH clinical mortality risk prediction models and improved performance when combined and added to NT-proBNP. Clinical risk scores offer excellent predictive models, but require multiple tests; adding blood biomarkers to models can improve prediction or can enable more frequent, noninvasive monitoring of risk in PAH to support therapeutic decision-making.
Collapse
Affiliation(s)
- Megan Griffiths
- Blalock-Taussig-Thomas Congenital Heart Center, Department of Pediatrics, Johns Hopkins University, Baltimore, MD; Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern, Dallas, TX.
| | - Catherine E Simpson
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Jun Yang
- Blalock-Taussig-Thomas Congenital Heart Center, Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - Dhananjay Vaidya
- Department of Internal Medicine, Johns Hopkins University, Baltimore, MD
| | - Melanie K Nies
- Blalock-Taussig-Thomas Congenital Heart Center, Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - Stephanie Brandal
- Blalock-Taussig-Thomas Congenital Heart Center, Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - Rachel Damico
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Paul Hassoun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Dunbar D Ivy
- Division of Pediatric Cardiology, Children's Hospital Colorado, Denver, CO
| | - Eric D Austin
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Michael W Pauciulo
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati
| | - Katie A Lutz
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati
| | - Lisa J Martin
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati
| | - Erika B Rosenzweig
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Raymond L Benza
- Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - William C Nichols
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati
| | - Cedric Manlhiot
- Blalock-Taussig-Thomas Congenital Heart Center, Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - Allen D Everett
- Blalock-Taussig-Thomas Congenital Heart Center, Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
2
|
Sleem B, El Rassi C, Zareef R, Bitar F, Arabi M. NT-proBNP cardiac value in COVID-19: a focus on the paediatric population. Cardiol Young 2024:1-10. [PMID: 38528805 DOI: 10.1017/s1047951124000283] [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: 03/27/2024]
Abstract
NT-proBNP is a peptide related to brain natriuretic peptide, a cardiac biomarker and a member of the natriuretic family of peptides. NT-proBNP has demonstrated its clinical utility in the assessment of a wide spectrum of cardiac manifestations. It is also considered a more precise diagnostic and prognostic cardiac biomarker than brain natriuretic peptide. With the appearance of the Severe Acute Respiratory Syndrome Coronavirus 2 virus and the subsequent COVID-19 pandemic, diagnosis of heart implications began to pose an increasing struggle for the physician. Echocardiography is considered a central means of evaluating cardiac disorders like heart failure, and it is considered a reliable method. However, other diagnostic methods are currently being explored, one of which involves the assessment of NT-proBNP levels. In the literature that involves the adult population, significant positive correlations were drawn between the levels of NT-proBNP and COVID-19 outcomes such as high severity and fatality. In the paediatric population, however, the literature is scarce, and most of the investigations assess NT-proBNP in the context of Multiple Inflammatory Syndrome in Children, where studies have shown that cohorts with this syndrome had elevated levels of NT-proBNP when compared to non-syndromic cohorts. Thus, more large-scale studies on existing COVID-19 data should be carried out in the paediatric population to further understand the prognostic and diagnostic roles of NT-proBNP.
Collapse
Affiliation(s)
- Bshara Sleem
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christophe El Rassi
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana Zareef
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Bitar
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, Division of Pediatric Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, Division of Pediatric Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
3
|
NT-proBNP Concentrations in the Umbilical Cord and Serum of Term Neonates: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12061416. [PMID: 35741227 PMCID: PMC9222102 DOI: 10.3390/diagnostics12061416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 05/29/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
The detection of NT-proBNP levels both in umbilical cord blood (UCB) samples and in serum samples collected from healthy term neonates during the neonatal period. A systematic review of relevant literature in accordance with PRISMA guidelines was conducted. For quality appraisal, the potential risk of bias was assessed using the BIOCROSS evaluation tool. The random-effects and fixed-effects models were used to calculate weighted mean differences with a corresponding 95% confidence interval. A total of forty (40) studies met the inclusion criteria for the systematic review. After further examination, eighteen (18) studies (1738 participants) from the UCB sample group and fourteen (14) studies (393 participants) from the serum sample group were selected to perform a meta-analysis. Using the fixed-effects model, the mean intervals of NT-proBNP in UCB and serum samples were 492 pg/mL (95% CI: 480−503 pg/mL) and 1341 pg/mL (95% CI: 1286−1397 pg/mL), respectively. A higher concentration of ΝΤ-proBNP was observed in the serum sample group compared to the UCB samples (p < 0.001). We present the intervals of NT-proBNP in UCB and in the serum of healthy term neonates. The determination of the potential effect of perinatal factors on the biomarker’s reference range was also aimed.
Collapse
|
4
|
Rodriguez-Gonzalez M, A Perez-Reviriego A, Castellano-Martinez A. Current role of cardiac biomarkers in extra-cardiac diseases in children. Biomark Med 2020; 14:1183-1187. [PMID: 33021387 DOI: 10.2217/bmm-2020-0232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Moises Rodriguez-Gonzalez
- Pediatric Cardiology Department of Puerta del Mar University Hospital, Cadiz, Spain
- Biomedical Research & Innovation Institute of Cadiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cadiz, Spain
| | - Alvaro A Perez-Reviriego
- Pediatric Cardiology Department of Puerta del Mar University Hospital, Cadiz, Spain
- Biomedical Research & Innovation Institute of Cadiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cadiz, Spain
| | - Ana Castellano-Martinez
- Pediatric Nephrology Department of Puerta del Mar University Hospital, Cadiz, Spain
- Biomedical Research & Innovation Institute of Cadiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cadiz, Spain
| |
Collapse
|
5
|
Establishment and Verification of Sex- and Age-Specific Serum Electrolyte Reference Intervals in Healthy Han Children in Changchun, Northeastern China. BIOMED RESEARCH INTERNATIONAL 2020; 2019:8282910. [PMID: 31886255 PMCID: PMC6899288 DOI: 10.1155/2019/8282910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/19/2019] [Accepted: 09/28/2019] [Indexed: 11/17/2022]
Abstract
For lack of feasible interval values from population differences and potential analytical discrepancies, it is essential to ascertain potassium (K), sodium (Na), chlorine (Cl), calcium (Ca), and phosphorus (P) ions reference intervals within Chinese children to fill the gap. Healthy children (n = 1391, 2–<15 years old) were recruited from communities and schools to establish sex- and age-specific serum electrolyte reference intervals of Han children in Changchun, China. Levels of serum K, Na, Cl, Ca, and P were measured using a Hitachi 7600-210 automatic biochemical analyzer. Reference intervals were established according to Clinical and Laboratory Standards Institute EP28-A3c guidelines. Data from five representative hospitals located across Changchun were used to verify pediatric serum electrolyte reference intervals. Values were different from adult reference intervals in China. There were sex-specific differences in Na, Cl, Ca, and P reference intervals in 13-<14 children. Serum Na, Cl, and Ca reference intervals showed stable trends within early age groups but fluctuated in teens. Each serum electrolyte had ≤3 age-specific reference intervals. Five laboratories suggested reference intervals were applicable across Changchun.
Collapse
|
6
|
Establishment of normal reference values of NT-proBNP and its application in diagnosing acute heart failure in children with severe hand food and mouth disease: Erratum. Medicine (Baltimore) 2020; 99:e19688. [PMID: 32195975 PMCID: PMC7220746 DOI: 10.1097/md.0000000000019688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
7
|
Zhang Z, Wang J, Zhu Y, Zhang H, Wang H. Astragaloside IV alleviates myocardial damage induced by type 2 diabetes via improving energy metabolism. Mol Med Rep 2019; 20:4612-4622. [PMID: 31702040 PMCID: PMC6797977 DOI: 10.3892/mmr.2019.10716] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/30/2019] [Indexed: 02/06/2023] Open
Abstract
The aim of the present study was to evaluate the protective effect and mechanism of Astragaloside IV (ASIV) on myocardial injury induced by type 2 diabetes, with a focus on energy metabolism. Blood glucose, the hemodynamic index, left ventricular weight/heart weight (LVW/HW), the left ventricular systolic pressure (LVSP), the left ventricular end diastolic pressure (LVEDP) and cell survival rate were measured in streptozotocin‑induced diabetes model rats. Western blot analysis, PCR, hematoxylin‑eosin and TUNEL staining, flow cytometry and ELISA were used to detect: i) Cardiomyocyte damage indicators such as atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), cytochrome c (Cyt C), caspase‑3, cleaved caspase‑3 and the apoptotic rate; ii) energy metabolism indicators such as ATP/AMP and ADP/AMP; and iii) energy metabolism associated pathway proteins such as peroxisome proliferator‑activated receptor γ coactivator 1‑α (PGC‑1α) and nuclear respiratory factor 1 (NRF1). The present demonstrated increased blood glucose, LVW/HW, LVSP, LVEDP and the cardiomyocyte damage indicators (ANP, BNP, Cyt C and caspase‑3), in the diabetic and high glucose‑treated groups, which were decreased by ASIV. The expression of NRF‑1 and PGC‑1α significantly changed in the model group and was markedly improved following ASIV treatment. Furthermore, the abnormal energy metabolism in the model group was reversed by ASIV. According to the results, ASIV can regulate energy metabolism by regulating the release of PGC‑1α and NRF1 to rescue the abnormal energy metabolism caused by diabetes mellitus, thus decreasing the myocardial damage caused by diabetic cardiomyopathy.
Collapse
Affiliation(s)
- Zhen Zhang
- Key Laboratory of Cardiovascular and Cerebrovascular Drug Research of Liaoning Province, Jinzhou Medical University, Jinzhou, Liaoning 121001, P.R. China
| | - Jing Wang
- The First Affiliated Hospital, Jinzhou Medical University, Jinzhou, Liaoning 121001, P.R. China
| | - Yingwei Zhu
- Institute of Physical Education, Bohai University, Jinzhou, Liaoning 121013, P.R. China
| | - Hui Zhang
- Key Laboratory of Cardiovascular and Cerebrovascular Drug Research of Liaoning Province, Jinzhou Medical University, Jinzhou, Liaoning 121001, P.R. China
| | - Hongxin Wang
- Key Laboratory of Cardiovascular and Cerebrovascular Drug Research of Liaoning Province, Jinzhou Medical University, Jinzhou, Liaoning 121001, P.R. China
| |
Collapse
|
8
|
Shao S, Luo C, Zhou K, Hua Y, Wu M, Liu L, Liu X, Wang C. The role of age-specific N-terminal pro-brain natriuretic peptide cutoff values in predicting intravenous immunoglobulin resistance in Kawasaki disease: a prospective cohort study. Pediatr Rheumatol Online J 2019; 17:65. [PMID: 31533770 PMCID: PMC6751871 DOI: 10.1186/s12969-019-0368-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/09/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The prediction of resistance to intravenous immunoglobulins (IVIG) is currently still one of the main research areas in Kawasaki disease (KD). Several studies have reported on the use of N-terminal pro-brain natriuretic peptide (NT-ProBNP) to this end. However, considering the age-dependency of NT-ProBNP levels, age- specific NT-ProBNP cutoff levels to predict IVIG resistance in KD might be more precise and should be evaluated. METHODS A prospective cohort study with standardized data collection involving 393 KD patients aged 1 month to 125 months was conducted between June 2015 and April 2018. The demographic characteristics, clinical manifestations and laboratory data were compared between the patients responding to initial intravenous immunoglobulin (IVIG-response group) and those who did not (IVIG-resistance group). We further distinguished four subgroups according to patients' age (< 1 year, 1-2 years, 2-6 years, > 6 years). The cutoff values of NT-ProBNP for the prediction of IVIG resistance overall and in the subgroups were obtained using receiver operating characteristic (ROC) analysis. RESULTS In all KD patients, the level of NT-ProBNP was significantly higher in the IVIG-resistance compared to the IVIG-response group (P = 0.006). This findings was similar in the subgroups except for patients older than six years. The best cutoff values of NT-ProBNP to predict IVIG resistance were 3755 pg/ml for all KD patients, 3710 pg/ml, 2800 pg/ml, 2480 pg/ml for those aged 2-6 years, 1-2 years and < 1 year, respectively. The corresponding sensitivities were 44.0, 52.2, 50.0 and 75.0%, while the specifities were 84.1, 86.3, 77.9 and 71.8%, respectively. CONCLUSIONS NT-proBNP is a complementary laboratory marker for the prediction of IVIG resistance in KD patients, particularly for those younger than one year. Applying age-specific cutoff values is more precise than one value for all ages.
Collapse
Affiliation(s)
- Shuran Shao
- 0000 0001 0807 1581grid.13291.38Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road Chengdu, Chengdu, 610041 Sichuan China ,0000 0001 0807 1581grid.13291.38The Cardiac development and early intervention unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China
| | - Chunyan Luo
- 0000 0001 0807 1581grid.13291.38Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Kaiyu Zhou
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road Chengdu, Chengdu, 610041, Sichuan, China. .,The Cardiac development and early intervention unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China. .,Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Yimin Hua
- 0000 0001 0807 1581grid.13291.38Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road Chengdu, Chengdu, 610041 Sichuan China ,0000 0001 0807 1581grid.13291.38The Cardiac development and early intervention unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China ,0000 0004 0369 313Xgrid.419897.aKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan China ,0000 0001 0807 1581grid.13291.38Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China
| | - Mei Wu
- 0000 0001 0807 1581grid.13291.38Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road Chengdu, Chengdu, 610041 Sichuan China ,0000 0001 0807 1581grid.13291.38The Cardiac development and early intervention unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China
| | - Lei Liu
- 0000 0001 0807 1581grid.13291.38Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road Chengdu, Chengdu, 610041 Sichuan China ,0000 0001 0807 1581grid.13291.38The Cardiac development and early intervention unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China
| | - Xiaoliang Liu
- 0000 0001 0807 1581grid.13291.38Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road Chengdu, Chengdu, 610041 Sichuan China ,0000 0001 0807 1581grid.13291.38The Cardiac development and early intervention unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China ,0000 0004 0369 313Xgrid.419897.aKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan China
| | - Chuan Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road Chengdu, Chengdu, 610041, Sichuan, China. .,The Cardiac development and early intervention unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China. .,Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
| |
Collapse
|