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

Abstract

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

A Review of Adrenomedullin in Pediatric Patients: A Useful Biomarker

“…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. The AUC for pro-ANP was greater than that of MR-proADM, but without significant differences for both cases; however, in the multivariate analysis, the only biomarker kept as an independent predictor was pro-ANP [ 48 ].…”

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

“…Studies show that as patients received treatment and their NYHA score improved, their atrial naturetic peptide assay level reduced in keeping with similar studies focusing on brain naturetic peptide. [48][49][50][51] Atrial naturetic peptide values were found to be highest amongst children with cardiomyopathy compared to CHD. 50 When atrial naturetic peptide and brain naturetic peptide are compared directly in assessment of paediatric heart failure, the changes noted in brain naturetic peptide/NT-proBNP are reflected by atrial naturetic peptide/MR-proANP.…”

The beneficial role of simple inflammatory blood indices in pediatric cardiology

“…9 The assessment of cardiovascular disease prognosis and procedural outcomes highlighted several parameters and biomarkers. [10][11][12][13][14][15] Many of them, including interleukins, microribonucleic acids (microRNAs), tumor necrosis factor alpha (TNF-α), and platelet-leukocyte aggregates, 16,17 have high prognostic value. However, using such markers in clinical practice is not possible, as a profound analysis of inflammatory phenomena is challenging and not costeffective.…”