Change in N-terminal pro B-type natriuretic peptide levels and clinical outcomes in children undergoing congenital heart surgery.

OBJECTIVE

To examine the association between change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and prognosis after congenital heart disease (CHD) surgery.

METHODS

NT-proBNP level was measured in 873 children before and at 1, 12, 36 and 72 h after cardiac surgery. Patients were followed up at 30, 90 and 180 days after surgery. The clinical outcomes of interest included prolonged intensive care unit (ICU) stay (>3 days), prolonged mechanical ventilation (>48 h), and occurrence of adverse events (i.e. death, readmission, and infection).

RESULTS

NT-proBNP increased after surgery, peaking at 12 h, and decreased progressively thereafter. Median NT-proBNP change (i.e. preoperative minus postoperative level at 72 h after surgery) was -1212.68 pg/mL (interquartile range: -3099.87 to -66.81). Adverse events occurred in 29.4% of patients. Multivariate logistic regression showed that lower body surface area (BSA), higher, the Risk Adjustment for Congenital Heart Surgery-1 score and smaller age were significantly associated with an increased risk of prolonged ICU-stay and mechanical ventilation. A decrease or a slight increase in NT-proBNP was associated with a lower risk. In multivariate cox regression, a decrease or a slight increase in NT-proBNP was associated with a lower risk of death. In addition to quartile of the NT-proBNP change, BSA was a significant predictor for adverse events. The associations for prolonged ICU-stay and mechanical ventilation were U-shaped, according to the restricted cubic spline models. The association between NT-proBNP change and death was inconclusive.

CONCLUSIONS

Increase in NT-proBNP may be a useful marker for adverse outcomes in children with CHD after cardiac surgery.