Prognostic value of biomarkers after cardiopulmonary bypass in pediatrics: The prospective PANCAP study

Pérez, Sandra Martínez; Jordan, Iolanda; Corniero, Patricia; Balaguer, Mònica; Solé‐Ribalta, Anna; Esteban, Esther; Esteban, Elisabeth; Cambra, Francisco José

doi:10.1371/journal.pone.0215690

Cited by 7 publications

(8 citation statements)

References 51 publications

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“…The role of proADM in sepsis is linked to its biological function as both a potent vasodilator and compensatory protein. In children, proADM determined within the first 24 hours following cardiac surgery seems to predict a greater need for postoperative respiratory support [31]. According to our results, proADM values are also useful before cardiac surgery, because high values can predict an increased need for respiratory support.…”

Section: Plos Onesupporting

confidence: 55%

Pro-atrial natriuretic peptide and pro-adrenomedullin before cardiac surgery in children. Can we predict the future?

Pérez¹,

Girona‐Alarcón²,

Corniero³

et al. 2020

PLoS ONE

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Introduction and objective Pro-atrial natriuretic peptide (proANP) and pro-adrenomedullin (proADM) levels increase in acute heart failure and sepsis. After cardiac surgery, children may require increased support in the intensive care unit and may develop complications. The aim of this study was to evaluate the utility of proANP and proADM values, determined prior to cardiac surgery, for predicting the need for increased respiratory or inotropic support during the post-operative period. Methods This was a prospective study in children. Biomarkers were analyzed before surgery using a single blood test. The primary endpoints were the need for greater respiratory and/or inotropic support during the post-operative period. Secondary endpoints were the relationship between these biomarkers and complications after surgery. Results One hundred thirteen patients were included. ProANP and proADM were higher in children who required greater respiratory and inotropic support, especially proANP; for increased respiratory support, 578.9 vs. 106.6 pmol/L (p = 0.004), and for increased inotropic support, 1938 vs. 110.4 pmol/L (p = 0.002). ProANP had a greater AUC than proADM for predicting increased respiratory support after surgery: 0.791 vs. 0.724. A possible cutoff point for proANP could be � 325 pmol/L (sensitivity = 66.7% and specificity = 88.8%). In the multivariate analysis, the logarithmic transformation of proANP was independently associated with the need for increased respiratory support (OR = 3.575). Patients who presented a poor

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Section: Plos Onesupporting

confidence: 55%

Pro-atrial natriuretic peptide and pro-adrenomedullin before cardiac surgery in children. Can we predict the future?

Pérez¹,

Girona‐Alarcón²,

Corniero³

et al. 2020

PLoS ONE

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“…Regarding the need for intensive support and complications after CPB, MR-proADM and pro-atrial natriuretic peptide (pro-ANP) were associated with the need for MV, with respective cut-off values of 1.22 nmol/L and 215.3 pmol/L potentially indicating mechanical ventilation (MV) requirement with respective AUCs of 0.721 and 0.746 at admission and 0.738 and 0.753 at 24–36 h. PCT levels greater than 1.9 ng/mL at 24–36 h post-CPB were predictive for invasive bacterial infection (IBI), with an AUC of 0.896 (Se 95.5, Sp 95.5, PPV 79.1, NPV 96.2) [ 47 ]. Pro-ANP and MR-proADM levels before cardiac surgery were also higher in those patients with an increased need for ventilatory and inotropic support after the surgical intervention.…”

Section: Resultsmentioning

confidence: 99%

A Review of Adrenomedullin in Pediatric Patients: A Useful Biomarker

2022

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Adrenomedullin has several properties. It acts as a potent vasodilator, has natriuretic effects, and reduces endothelial permeability. It also plays a role in initiating the early hyperdynamic phase of sepsis. Since its discovery, many articles have been published studying the uses and benefits of this biomarker. The aim of this review is to determine the usefulness of adrenomedullin in pediatric patients. Relevant studies covering adrenomedullin in pediatrics (<18 years) and published up until August 2021 were identified through a search of MEDLINE, PubMed, Embase, Web of Science, Scopus, and Cochrane. Seventy studies were included in the present review, most of them with a low level of evidence (IV to VI). Research on adrenomedullin has primarily been related to infection and the cardiovascular field. The performance of adrenomedullin to quantify infection in children seems satisfactory, especially in sepsis. In congenital heart disease, this biomarker seems to be a useful indicator before, during, and after cardiopulmonary bypass. Adrenomedullin seems to be useful in the pediatric population for a large variety of pathologies, especially regarding infection and cardiovascular conditions. However, it should be used in combination with other biomarkers and clinical or analytical variables, rather than as a single tool.

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“…77,78 One study of postoperative MR pro-ADM levels suggested a cut-off value of MR pro-ADM of 1.223nmol/L may indicate higher likelihood of mechanical ventilation requirement post operatively. 79 sST2 Soluble suppression of tumorigenicity-2 is a circulating form of suppression of tumorigenicity-2glycoprotein. ST2L is a receptor for interleukin-33 and the interaction of interleukin-33 and ST2L is cardioprotective by reducing fibrosis and cardiomyocyte hypertrophy in experimental models.…”

Section: Mr-proadmmentioning

confidence: 99%

Paediatric heart failure – understanding the pathophysiology and the current role of cardiac biomarkers in clinical practice

et al. 2023

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Introduction: Paediatric heart failure is a common clinical syndrome that may be experienced by children with congenital heart disease (CHD) and/or cardiomyopathy. It is characterised by clinical signs/symptoms which reflect the underlying pathophysiology based on one of three main clinical states: Pulmonary over-circulation, pressure overload, and ventricular failure. Current diagnosis relies on clinical assessment and echocardiogram imaging as cardiac biomarkers has been predominantly scientific to date. This review provides a comprehensive overview of paediatric heart failure pathophysiology and considers the available evidence for cardiac biomarkers in this setting. Methods: A literature review was completed using MEDLINE ALL, EMBASE, and PubMed on 10th November, 2022. Search terms included biomarkers, heart failure, heart defects, congenital heart disease, fontan circulation, single ventricle circulation, cardiomyopathy, and child. This allowed the identification of individual cardiac biomarkers which are the focus of this review. These included NT-proBNP, MR-proANP, MR-proADM, troponin, sST2, galectin 3, and growth differentiation factor-15. Results: Paediatric studies have established reference ranges for NT-proBNP and troponin for children with structurally normal hearts. Of all the biomarkers reviewed, NT-proBNP appears to correlate most closely with symptoms of heart failure and ventricular dysfunction on echocardiogram. However, there remains limited longitudinal data for NT-proBNP, and no validated reference ranges for patients with CHD and/or cardiomyopathy. None of the other biomarkers reviewed were consistently superior to NT-proBNP. Conclusion: Further large paediatric studies of patients with heart failure are needed to validate NT-proBNP in CHD and to evaluate the role of novel biomarkers in specific types of CHD, e.g. single ventricle physiology.

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Prognostic value of biomarkers after cardiopulmonary bypass in pediatrics: The prospective PANCAP study

Cited by 7 publications

References 51 publications

Pro-atrial natriuretic peptide and pro-adrenomedullin before cardiac surgery in children. Can we predict the future?

Pro-atrial natriuretic peptide and pro-adrenomedullin before cardiac surgery in children. Can we predict the future?

A Review of Adrenomedullin in Pediatric Patients: A Useful Biomarker

Paediatric heart failure – understanding the pathophysiology and the current role of cardiac biomarkers in clinical practice

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