The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire; Department of Epidemiology, Dartmouth Geisel School of Medicine, Hanover, New Hampshire.
Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ann Thorac Surg. 2020 Dec;110(6):2070-2075. doi: 10.1016/j.athoracsur.2020.02.056. Epub 2020 Apr 1.
Approximately 10% to 20% of children are readmitted after congenital heart surgery. Very little is known about biomarkers as predictors of risk of unplanned readmission after pediatric congenital heart surgery. Novel cardiac biomarker ST2 may be associated with risk of unplanned readmission. ST2 concentrations are believed to reflect cardiovascular stress and fibrosis. Our objective was to explore the relationship between pre- and postoperative ST2 biomarker levels and risk of readmission within 1 year after congenital heart surgery.
We prospectively enrolled pediatric patients aged < 18 years who underwent at least 1 congenital heart operation at Johns Hopkins Hospital from 2010 to 2014. Plasma samples were collected immediately before surgery and at the end of bypass. We used Kaplan-Meier survival analysis and multivariable Cox regression models to adjust for variables used in The Society of Thoracic Surgeons Congenital Heart Surgery Database mortality risk model.
Of our cohort of 145 patients, we found 39 children with readmissions within 365 days. The median time to unplanned readmission was 54 days (interquartile range, 10-153). Kaplan-Meier analysis demonstrated a significant difference across terciles of pre- and postoperative ST2 biomarker levels. After adjustment, elevated serum levels of ST2 measured preoperatively and postoperatively were associated with increased risk of readmission (hazard ratio, 2.5-3.7; all P < .05).
Elevated levels of ST2 are significantly associated with increased risk of unplanned readmission within 1 year after pediatric congenital heart surgery. Novel serum biomarker ST2 can be used for risk stratification or estimating postsurgical prognosis.
约 10%至 20%的儿童在先天性心脏病手术后会再次入院。对于预测小儿先天性心脏病手术后非计划性再入院风险的生物标志物，我们知之甚少。新型心脏生物标志物 ST2 可能与非计划性再入院的风险相关。ST2 浓度被认为反映了心血管压力和纤维化。我们的目的是探讨手术前和手术后 ST2 生物标志物水平与先天性心脏病手术后 1 年内再入院风险之间的关系。
我们前瞻性纳入了 2010 年至 2014 年在约翰霍普金斯医院接受至少 1 次先天性心脏手术的年龄<18 岁的小儿患者。在手术前和体外循环结束时采集血浆样本。我们使用 Kaplan-Meier 生存分析和多变量 Cox 回归模型，根据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使用的变量进行调整。
在我们的 145 例患者队列中，我们发现 39 例患儿在 365 天内再次入院。非计划性再入院的中位时间为 54 天（四分位距，10-153）。Kaplan-Meier 分析表明，术前和术后 ST2 生物标志物水平的三分位数之间存在显著差异。调整后，术前和术后测量的血清 ST2 水平升高与再入院风险增加相关（危险比，2.5-3.7；所有 P<0.05）。
ST2 水平升高与小儿先天性心脏病手术后 1 年内非计划性再入院风险显著相关。新型血清生物标志物 ST2 可用于风险分层或估计术后预后。
