新型生物标志物可改善小儿先天性心脏病术后 365 天再入院预测。
Novel Biomarkers Improve Prediction of 365-Day Readmission After Pediatric Congenital Heart Surgery.
机构信息
Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire.
Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
出版信息
Ann Thorac Surg. 2020 Jan;109(1):164-170. doi: 10.1016/j.athoracsur.2019.05.070. Epub 2019 Jul 16.
BACKGROUND
The purpose of this study was to evaluate the association between preoperative biomarker levels and 365-day readmission or mortality after pediatric congenital heart surgery.
METHODS
Children aged 18 years or younger undergoing congenital heart surgery (n = 145) at Johns Hopkins Hospital from 2010 to 2014 were enrolled in the prospective cohort. Novel biomarkers suppression of tumorgenicity 2, galectin-3, N-terminal prohormone brain natriuretic peptide, and glial fibrillary acidic protein were measured. The composite study endpoint was unplanned readmission within 365 days after discharge or mortality either in hospital during the surgical admission or within 365 days after discharge. A clinical model based on covariates used in The Society of Thoracic Surgeons Congenital Heart Surgery Database mortality risk model and an augmented model using the clinical model in conjunction with a novel biomarker panel were evaluated.
RESULTS
Readmission or mortality within 365 days of surgery occurred among 39 pediatric patients (27%). The clinical model alone resulted in a c-statistic of 0.719 (95% confidence interval, 0.63 to 0.81). The clinical model in conjunction with the log-transformed biomarkers improved the c-statistic to 0.805 (95% confidence interval, 0.73 to 0.88). The addition of biomarkers resulted in a significant improvement to the clinical model alone (P value = 0.035).
CONCLUSIONS
Novel biomarkers may add predictive value when assessing the likelihood of 365-day readmission or mortality after pediatric congenital heart surgery. After adjusting for clinical and novel biomarkers, preoperative and postoperative suppression of tumorgenicity 2 remained associated with 365-day readmission or mortality. Currently, The Society of Thoracic Surgeons clinical congenital mortality risk model can be applied to identify children with increased risk of repeat hospitalizations and postdischarge mortality and may inform preventative care interventions that aim to reduce these adverse events.
背景
本研究旨在评估术前生物标志物水平与小儿先天性心脏病手术后 365 天内再入院或死亡的相关性。
方法
2010 年至 2014 年，约翰霍普金斯医院收治的 18 岁以下先天性心脏病手术患儿（n=145）纳入前瞻性队列。检测新型生物标志物肿瘤抑制因子 2、半乳糖凝集素-3、N 端脑利钠肽前体和神经胶质纤维酸性蛋白。研究的复合终点为出院后 365 天内计划外再入院或死亡，包括住院期间手术期间死亡或出院后 365 天内死亡。评估基于胸外科医师学会先天性心脏病手术数据库死亡率风险模型中的协变量的临床模型，以及使用该临床模型联合新型生物标志物组的增强模型。
结果
39 例（27%）患儿在手术后 365 天内发生再入院或死亡。单独使用临床模型得出的 C 统计量为 0.719（95%置信区间，0.63 至 0.81）。结合对数转换生物标志物的临床模型将 C 统计量提高至 0.805（95%置信区间，0.73 至 0.88）。与单独使用临床模型相比，生物标志物的加入显著改善了模型（P 值=0.035）。
结论
新型生物标志物可能在评估小儿先天性心脏病手术后 365 天内再入院或死亡的可能性时提供预测价值。在调整了临床和新型生物标志物后，术前和术后肿瘤抑制因子 2 的抑制仍与 365 天内再入院或死亡相关。目前，胸外科医师学会临床先天性死亡率风险模型可用于识别有重复住院和出院后死亡风险增加的患儿，并可指导旨在减少这些不良事件的预防保健干预措施。
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