Biomarkers associated with 30‐day readmission and mortality after pediatric congenital heart surgery

Abstract

Objectives Novel cardiac biomarkers serum (suppression of tumorigenicity [ST2]) and Galectin‐3 may be associated with an increased likelihood of important events after cardiac surgery. Our objective was to explore the association between pre‐ and postoperative serum biomarker levels and 30‐day readmission or mortality for pediatric patients. Methods We prospectively enrolled pediatric patients <18 years of age who underwent at least one cardiac surgical operation at Johns Hopkins Children's Center from 2010 to 2014 (N = 162). Blood samples were collected immediately before surgery and at the end of bypass. We evaluated the association between pre‐ and postoperative Galectin‐3 and ST2 with 30‐day readmission or mortality, using backward stepwise logistic regression, adjusting for covariates based on the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Mortality Risk Model. Results In our cohort, 21 (12.9%) patients experienced readmission or mortality 30‐days from discharge. Before adjustment, preoperative ST2 terciles demonstrated a strong association with readmission and/or mortality after surgery (OR: 2.58; 95% CI: 1.17‐3.66 and OR: 4.37; 95% CI: 1.31‐14.57). After adjustment for covariates based on the STS congenital risk model, Galectin‐3 postoperative mid‐tercile was significantly associated with 30‐day readmission or mortality (OR: 6.17; 95% CI: 1.50‐0.43) as was the highest tercile of postoperative ST2 (OR: 4.98; 95% CI: 1.06‐23.32). Conclusions Elevated pre‐and postoperative levels of ST2 and Galectin‐3 are associated with increased risk of readmission or mortality after pediatric heart surgery. These clinically available biomarkers can be used for improved risk stratification and may guide improved patient care management.

N-terminal pro-brain natriuretic peptide as a biomarker for differentiating cardiac and pulmonary disease in term neonates with respiratory distress

“…Meanwhile, Parker et al [ 26 ] found that ST2 and Galectin-3, unlike BNP, are not developmentally regulated and therefore not confounded by age. Furthermore, the biologic and analytic variability of ST2 is much lower than BNP, suggesting that ST2 levels may be better in risk stratification and prognostication.…”

Biomarkers improve prediction of 30-day unplanned readmission or mortality after paediatric congenital heart surgery

“…[41][42][43][44][45][46][47][48] Kogon and colleagues identified ethnicity, pre-operative failure to thrive, and post-operative length of stay as significant predictors of readmission. 2 Others reported arrhythmia, post-pericardiotomy syndrome, and infectious complications were the most common readmission diagnoses, 46 or they found infectious complications to be a common readmission diagnosis in children who had previously undergone Norwood palliation for hypoplastic left heart syndrome. 47 The most common variables used to determine the risk of adverse outcomes following paediatric congenital heart surgery are based on the estimated risk of mortality following surgery, as defined by The Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model.…”

The Relationship Between Performance Indicators and Readmission of Patients With Open Heart Surgery: A Case Study in Iran

“…Parker et al 28 conducted a cohort study with 162 patients aged 18 years who had undergone cardiac surgery between 2010 and 2014. They found that 12.9% of the patients experienced readmission or death during the first 30 days after discharge.…”