Author:
Cantinotti Massimiliano,Giordano Raffaele,Scalese Marco,Molinaro Sabrina,della Pina Francesca,Storti Simona,Arcieri Luigi,Murzi Bruno,Marotta Marco,Pak Vitali,Poli Vincenzo,Iervasi Giorgio,Kutty Shelby,Clerico Aldo
Abstract
AbstractThe routine use of brain natriuretic peptide (BNP) in pediatric cardiac surgery remains controversial. Our aim was to test whether BNP adds information to predict risk in pediatric cardiac surgery.In all, 587 children undergoing cardiac surgery (median age 6.3 months; 1.2–35.9 months) were prospectively enrolled at a single institution. BNP was measured pre-operatively, on every post-operative day in the intensive care unit, and before discharge. The primary outcome was major complications and length ventilator stay >15 days. A first risk prediction model was fitted using Cox proportional hazards model with age, body surface area and Aristotle score as continuous predictors. A second model was built adding cardiopulmonary bypass time and arterial lactate at the end of operation to the first model. Then, peak post-operative log-BNP was added to both models. Analysis to test discrimination, calibration, and reclassification were performed.BNP increased after surgery (p<0.001), peaking at a mean of 63.7 h (median 36 h, interquartile range 12–84 h) post-operatively and decreased thereafter. The hazard ratios (HR) for peak-BNP were highly significant (first model HR=1.40, p=0.006, second model HR=1.44, p=0.008), and the log-likelihood improved with the addition of BNP at 12 h (p=0.006; p=0.009). The adjunction of peak-BNP significantly improved the area under the ROC curve (first model p<0.001; second model p<0.001). The adjunction of peak-BNP also resulted in a net gain in reclassification proportion (first model NRI=0.089, p<0.001; second model NRI=0.139, p=0.003).Our data indicates that BNP may improve the risk prediction in pediatric cardiac surgery, supporting its routine use in this setting.
Subject
Biochemistry, medical,Clinical Biochemistry,General Medicine
Reference72 articles.
1. Diagnostic prognostic and therapeutic relevance of type natriuretic peptide assay in children with congenital heart diseases;Cantinotti;Clin Chem Lab Med,2011
2. Triiodothyronine supplementation in infants and children undergoing cardiopulmonary bypass a multicenter placebo - controlled randomized trial : age analysis;Portman;Circulation,2010
3. Quality measures for congenital and pediatric cardiac surgery;Jacobs;World J Pediatr Congenit Heart,2012
4. AHA guideline for the management of heart failure : a report of the American College of Cardiology Foundation Heart Association Task Force on practice guidelines;Yancy;American Circulation,2013
5. Impact of cardiac surgery on plasma levels of type natriuretic peptide in children with congenital heart disease;Kitzsteiner;Int J Cardiol,2007
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