Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
Eur J Pediatr. 2022 Mar;181(3):1017-1028. doi: 10.1007/s00431-021-04278-7. Epub 2021 Oct 22.
Newborns are the most vulnerable patients after cardiac surgery. Although mortality risk scores before surgery may help predict the risk of poor outcome, new tools are required, and biomarkers could add objective data to these tools. The aim of this study was to assess the ability of mid-regional pro-adrenomedullin (pro-ADM) and pro-atrial natriuretic peptide (pro-ANP) to predict poor outcome after cardiac surgery. This is a pilot diagnostic accuracy study that includes newborns and infants under 2 months admitted to an intensive care unit after cardiac surgery. Pro-ADM and pro-ANP were determined immediately upon admission. Poor outcome was defined as mortality, cardiac arrest, requiring extracorporeal support, requiring renal replacement therapy, or neurological injury. Forty-four patients were included. Twenty-six (59%) had a STAT category of ≥ 4. Ten patients (22.7%) presented a poor outcome, four of whom (9.1%) died. Pro-ADM was higher in patients with poor outcome (p = 0.024) and death (p = 0.012). Pro-ADM showed the best area under curve (AUC) for predicting poor outcome (0.735) and mortality alone (0.869). A pro-ADM of 2 nmol/L had a Sn of 75% and a Sp of 85% for predicting mortality. Pro-ADM > 2 nmol/L was independently associated with poor outcome (OR 5.8) and mortality (OR 14.1). Although higher pro-ANP values were associated with poor outcomes, no cut-off point were found. The combination of STAT ≥ 4 and the biomarkers did not enhance predictive power for poor outcome or mortality.Conclusion: Pro-ADM and pro-ANP determined immediately after surgery could be helpful for stratifying risk of poor outcome and mortality in newborns. What is Known: • Some congenital heart diseases must be corrected/palliated during the first days of life. A useful tool to predict the risk of severe complications has not been proposed. • Most unstable newborns would have higher values of biomarkers such as pro-ADM and pro-ANP related to shock and compensatory actions. What is New: • Pro-ADM and pro-ANP seem to be good biomarkers to predict poor outcome after cardiac surgery. A pro-ADM < 2 nmol/L would imply a low likelihood of a poor outcome. • Deepening the analysis of biomarkers can help in making decisions to prevent/treat complications.
新生儿是心脏手术后最脆弱的患者。尽管术前死亡率风险评分可能有助于预测不良结局的风险，但需要新的工具，生物标志物可以为这些工具提供客观数据。本研究旨在评估中区域促肾上腺髓质素（pro-ADM）和前心房利钠肽（pro-ANP）预测心脏手术后不良结局的能力。这是一项包括接受心脏手术后入住重症监护病房的新生儿和 2 个月以下婴儿的诊断准确性研究。pro-ADM 和 pro-ANP 在入院时立即测定。不良结局定义为死亡、心脏骤停、需要体外支持、需要肾脏替代治疗或神经损伤。共纳入 44 例患者。26 例（59%）的 STAT 分类≥4。10 例（22.7%）患者出现不良结局，其中 4 例（9.1%）死亡。pro-ADM 在预后不良的患者（p=0.024）和死亡患者（p=0.012）中更高。pro-ADM 预测不良结局（AUC 为 0.735）和死亡率（AUC 为 0.869）的曲线下面积（AUC）最佳。pro-ADM 为 2 nmol/L 时，预测死亡率的敏感性为 75%，特异性为 85%。pro-ADM＞2 nmol/L 与不良结局（OR 5.8）和死亡率（OR 14.1）独立相关。尽管 pro-ANP 值较高与不良结局相关，但未发现截断值。STAT≥4 和生物标志物的联合并未增强不良结局或死亡率的预测能力。结论：术后立即测定 pro-ADM 和 pro-ANP 有助于分层新生儿不良结局和死亡率的风险。已知：· 一些先天性心脏病必须在生命的头几天得到纠正/姑息治疗。尚未提出预测严重并发症风险的有用工具。· 大多数不稳定的新生儿的标志物（如与休克和代偿性反应相关的 pro-ADM 和 pro-ANP）值较高。新内容：· pro-ADM 和 pro-ANP 似乎是预测心脏手术后不良结局的良好生物标志物。pro-ADM＜2 nmol/L 意味着不良结局的可能性较低。· 深入分析生物标志物有助于做出预防/治疗并发症的决策。
