CA125: a novel cardiac biomarker for infants with congenital diaphragmatic hernia

Schroeder, Lukas; Pugnaloni, Flaminia; Dolscheid‐Pommerich, Ramona; Geipel, A.; Berg, Christoph; Holdenrieder, Stefan; Müeller, Andreas; Kipfmueller, Florian

doi:10.1038/s41390-022-02130-8

Cited by 4 publications

(1 citation statement)

References 36 publications

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“…The standard of care of CDH infants at our institution was described in a publication elsewhere and is described in detail below. 13 The prenatal assessment and risk stratification included estimation of the lung size using the observed to expected lung-to-head ratio (o/e LHR) and liver position on ultrasound (measured at 27-29 weeks' of gestational age (GA)). Right-and left-sided CDH and infants with intrauterine fetal endoluminal tracheal occlusion procedure were included in the analysis.…”

Section: Respiratory and Cardiac Supportmentioning

confidence: 99%

A comparative analysis of the Vasoactive‐Inotropic Score, the Vasoactive‐Ventilation‐Renal Score, and the Oxygenation Index as outcome predictors in infants with a congenital diaphragmatic hernia

Schroeder,

Pommer,

Geipel

et al. 2023

Pediatric Pulmonology

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ObjectivesTo date, different severity scores and indices are available to predict outcome in infants with a congenital diaphragmatic hernia (CDH). The Oxygenation Index (OI) and the Vasoactive‐Inotropic Score (VIS) has already been evaluated in the CDH population. The Vasoactive‐Ventilation‐Renal (VVR) Score was recently evaluated as new severity score in several studies on infants with need for cardiac surgery. The score was shown to outperform the VIS and OI as outcome predictors in these infants, but no data are available regarding the evaluation of the VVR Score in CDH infants.Patients and MethodsThis was a retrospective single‐center analysis at the University Children's Hospital, Bonn, Germany, during the study period from January 2019 until December 2022. Of 108 CDH infants treated at our institution, a final cohort of 100 neonates met the inclusion criteria. Inclusion criteria: diagnosis of CDH (right‐sided, left‐sided, or bilateral). Exclusion criteria: early mortality (before surgical correction of the diaphragm), palliative care after birth, no available data for OI, VIS, and VVR Score calculation. The OI, the VIS, and the VVR Score were calculated at three selected timepoints: at 48–72 h after birth (T1), before surgery (T2), and after surgery (T3).Main ResultsThe primary clinical endpoint (in‐hospital mortality) was reached in 21% of the infants. Infants surviving to discharge were allocated to group A, infants with fatal outcome to group B. In the univariate analysis, the OI was significantly higher in infants allocated to group B at T2 (p < .001), and T3 (p < .001). The VIS was significantly higher only at T1 in infants allocated to group B (p = .001). The VVR Score was significantly higher at T1 (p = .017), and at T3 (p = .002) in infants not surviving to discharge. In the multivariate analysis, the OI at T2 + T3 (p < .001), the VIS at T1 (p = .048), and the VVR Score at T1 + T3 (p = .023, and p = .048, respectively) remained significantly associated with in‐hospital mortality. The OI presented the highest area under the curve (AUC) at T2 and T3 (T2:0.867, p = .001; T3:0.833, p = .000) regarding the primary endpoint in the overall cohort. In the subgroup of infants without need for extracorporeal membrane oxygenation (ECMO) therapy (n = 60) the VVR Sore presented the best performance with an AUC of 0.942 (p = .000) at T3.ConclusionThe severity scores OI, VIS, and VVR‐Score are independent predictors of in‐hospital mortality in CDH infants. The OI seems to outperform the VIS and VVR‐Score as outcome predictor immediately before and after CDH surgery, whereas the VVR Score presented the best performance in the subgroup of CDH infants without need for ECMO and mild‐to‐moderate CDH defects.

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Section: Respiratory and Cardiac Supportmentioning

confidence: 99%

A comparative analysis of the Vasoactive‐Inotropic Score, the Vasoactive‐Ventilation‐Renal Score, and the Oxygenation Index as outcome predictors in infants with a congenital diaphragmatic hernia

Schroeder,

Pommer,

Geipel

et al. 2023

Pediatric Pulmonology

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Longitudinal evaluation of hemodynamic blood and echocardiographic biomarkers for the prediction of BPD and BPD-related pulmonary hypertension in very-low-birth-weight preterm infants

Schroeder,

Ebach,

Melaku

et al. 2024

Eur J Pediatr

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Very-low-birth-weight infants (VLBW, < 1500 g) are at risk of developing bronchopulmonary dysplasia (BPD) and are at risk for BPD-related pulmonary hypertension (PH). The longitudinal measurement of innovative blood and echocardiographic biomarkers might allow for a risk stratification of these infants. A prospective single-center cohort study was conducted between 01/2021 and 06/2023. Inclusion criteria were the combination of a birth weight < 1500 g and a gestational age (GA) ≤ 30/0 weeks. Assessment timepoints: T1 (day 7), T2 (day 28), and T3 (at 36 weeks post-menstrual age, PMA). Overall, 71 preterm infants were included for final analysis. The Zlog-transformed NTproBNPZlog (at T1 AUC 0.772; p = 0.019; at T2 AUC 0.874, p = 0.002), and endothelin-1 (ET1, at T1 AUC 0.789, p = 0.013) were identified as an early predictive biomarker for BPD/death in the univariate analysis. Additionally, echocardiographic markers of ventricular function and PH at T1 were predictive for BPD/death in the univariate analysis, with the highest predictivity found for the tricuspid annular plane systolic excursion-TAPSE (AUC 0.748, p = 0.016) and the pulmonary artery acceleration time to right ventricular ejection time (PAAT/RVET; AUC 0.744, p = 0.043). Regarding predictability of mortality alone NTroBNPZlog (at T1 AUC 0.973, p = 0.000), and CA125 (at T1 AUC 0.747, p = 0.008) were identified as potential predictors, as well as TAPSE (AUC 0.926, p = 0.000), and PAAT/RVET (AUC 0.985, p = 0.000) Several biomarkers including ET-1 (at T1 AUC 0.893, p = 0.000), TAPSE (AUC 0.974, p = 0.000), and PAAT/RVET (AUC 1.0, p = 0.000) at T1 were identified as univariate predictors for BPD-PH. In the multivariate analysis, no biomarker was identified as an independent predictor of the primary endpoint. Conclusion: Mainly at an early stage of postnatal neonatal care in VLBW preterm infants, several biomarkers were found to be associated with the combined endpoint BPD/death and BPD-PH. New candidates of blood biomarkers (NTproBNPZlog, ET-1, and CA125) and echocardiographic markers (TAPSE, PAAT/RVET) might serve as innovative predictors for BPD, BPD-PH, and adverse outcomes in VBLW infants. What is Known: • VLBW infants are at risk for the development of BPD and BPD-related PH, which both are main contributors for short and long-term morbidity and mortality. Several studies in the past focused on the evaluation of circulating blood biomarkers and biomarkers from echocardiographic assessment of these infants. But to date, there is still a lack on longitudinal prospective studies especially in VLBW infants. What is New: • For the first time, this set of selected blood biomarkers (with the first description of Zlog-transformed NTproBNP and CA125 in preterm infants) and several echocardiographic markers were analyzed in a prospective longitudinal study from birth until 36 weeks post menstrual age in VLBW infants. Our data help clinicians to identify preterm infants at risk for BPD, BPD-PH and death and to offer new candidates of biomarkers. This might help to facilitate decision making and guidance of therapy in these highly vulnerable patients.

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Exploring new perspectives on congenital diaphragmatic hernia: A comprehensive review

Renik-Jankowska,

Buczyńska,

Sidorkiewicz

et al. 2024

Biochimica et Biophysica Acta (BBA) - Molecular Basis of Diseas

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CA125: a novel cardiac biomarker for infants with congenital diaphragmatic hernia

Cited by 4 publications

References 36 publications

A comparative analysis of the Vasoactive‐Inotropic Score, the Vasoactive‐Ventilation‐Renal Score, and the Oxygenation Index as outcome predictors in infants with a congenital diaphragmatic hernia

A comparative analysis of the Vasoactive‐Inotropic Score, the Vasoactive‐Ventilation‐Renal Score, and the Oxygenation Index as outcome predictors in infants with a congenital diaphragmatic hernia

Longitudinal evaluation of hemodynamic blood and echocardiographic biomarkers for the prediction of BPD and BPD-related pulmonary hypertension in very-low-birth-weight preterm infants

Exploring new perspectives on congenital diaphragmatic hernia: A comprehensive review

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