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

Abstract

Objective: To evaluate the association between novel pre-and post-operative biomarker levels and 30-day unplanned readmission or mortality after pediatric congenital heart surgery. Methods: Children aged 18 years or younger undergoing congenital heart surgery (n=162) , at Johns Hopkins Hospital from 2010–2014 were enrolled in the prospective cohort. Collected novel pre-and postoperative biomarkers include: soluble suppression of tumorgenicity 2, Galectin-3, N-terminal prohormone of brain natriuretic peptide and glial fibrillary acidic protein. A model based on clinical variables from the Society of Thoracic Surgery database was developed and evaluated against two augmented models. Results: Unplanned readmission or mortality within 30-days of cardiac surgery occurred among 21 (13%) children. The clinical model augmented with pre-operative biomarkers demonstrated a statistically significant improvement over the clinical model alone with an receiver operating characteristics curve to 0.754 (95% CI:0.65 – 0.86) compared to 0.617 (95% CI: 0.47 – 0.76; p-value 0.012). The clinical model augmented with pre-and postoperative biomarkers demonstrated a significant improvement over the clinical model alone, with an receiver operating characteristics curve of 0.802 (95% CI: 0.72 – 0.89; p-value 0.003). Conclusions: Novel biomarkers add significant predictive value when assessing the likelihood of unplanned readmission or mortality after pediatric congenital heart surgery. Further exploration of the utility of these novel biomarkers during the peri- or post-operative period to identify early risk of mortality or readmission will aid in determining the clinical utility and application of these biomarkers into routine risk assessment.

Prognostic Value of NT-proBNP and 3 Months Readmission or Mortality after Congenital Heart Surgery

“…An understanding of a child's statistically anticipated risk of readmission or mortality may aid in determining the appropriate time for surgery, surgical alternatives and individualised operative care, and hospital release guidelines. A similar finding was made by Brown et al (10) .…”

Applicability of predictive models for 30-day unplanned hospital readmission risk in paediatrics: a systematic review

“…Adding one additional recommended article 31 , we found that this results in 109 records being included in the full-text assessment. Among the 84 excluded records, 2 were predictive model studies for 30-day HRs (ie, UHRs and planned HRs) with discrimination metrics 32 33 ; 12 studies analysed 30-day UHRs or 30-day HRs combined with another outcome (ie, emergency department return visits (n=5), 34–38 mortality (n=3) 39–41 and other complications (n=4) 42–45 ); 3 were predictive model studies for 30-day UHRs or 30-day HRs with no discrimination metrics 46–48 ; 5 were non-regression-based predictive model studies for 30-day UHRs or 30-day HRs in paediatrics 21 49–52 ; and 59 were prognostic factor studies for 30-day UHRs or 30-day HRs. Based on the full-text assessments (n=25) and the hand search of reference lists (n=3 53–55 ), 28 studies were included in the systematic review, with 6 of them 55–60 already presented in a previous systematic review 3 with a different focus.…”

Cardiac Biomarkers Associated With Hospital Length of Stay After Pediatric Congenital Heart Surgery

“…8 Additionally we found that pre-and postoperative ST2 was associated with unplanned 30-day readmission or death, whereas NT-proBNP was not useful in predicting 30-day readmission or death. 17 This evaluation of the utility of length of stay provides new insight to our team's guidance on the use of biomarkers, especially the utility of ST2, using an outcome variable with limited literature surrounding it.…”