Prognostic value of perioperative NT-proBNP after corrective surgery for pediatric congenital heart defects

Abstract

BackgroundIt is critically important to assess the prognostic value of NT-proBNP in the form of repeated measures among children undergoing surgery for congenital heart defects (CHD). The aim of the present study is to assess the value of repeated perioperative NT-proBNP in evaluating the time dependent and temporal trajectory in prognostics diagnosis during the perioperative period in a large series of children with CHD.MethodsRepeated measures of NT-proBNP from 329 consecutive children with CHD were obtained before and 1, 12, and 36 h after surgery, respectively. For fully utilizing longitudinal characteristics, we employed parallel cross-sectional logistic regression, a two stage mixed effect model and trajectories over time analysis to mine the predictive value of perioperative NT-proBNP on the binary outcome of prolonged intensive care unit (ICU) stay.ResultsThe two stage mixed effects model confirmed that both the mean NT-proBNP level (aOR = 1.46, P = 0.001) and the time trends had prognostic value on the prediction of prolonged ICU stay. In the fully adjusted logistic regression analyses based on gaussian distributions, “rapidly rising NT-proBNP” put the subjects at 5.4-times higher risk of prolonged ICU stay compared with “slowly rising” group (aOR = 5.40, P = 0.003).ConclusionsComprehensive assessment of the time dependent and temporal trajectory in perioperative NT-proBNP, indicated by repeated measurements, can provide more accurate identification of children with higher risk of prolonged ICU stay after CHD surgery.

The use of N-terminal (1–76) pro-brain natriuretic peptide in the aetiology of severe respiratory distress in the paediatric emergency department

“…25,26 In patients with congenital heart defects, basal N-terminal (1-76) pro-brain natriuretic peptide values were found to be high and were shown to be a postoperative prognostic indicator in patients requiring surgery. [27][28][29] In our study, the high N-terminal (1-76) pro-brain natriuretic peptide cut-off values in the patient group with congenital heart disease supported the presence of ventricular strain associated with the heart defect and higher basal N-terminal (1-76) pro-brain natriuretic peptide concentrations compared to patients without cardiac defects. In this group, heart failure monitoring can be done by intermittent N-terminal (1-76) pro-brain natriuretic peptide measurement, with an increase from basal N-terminal (1-76) pro-brain natriuretic peptide concentration suggesting progression to heart failure.…”

Prognostic value of N-terminal pro-form B-type natriuretic peptide (NT-proBNP) in patients with congenital heart disease undergoing cardiac surgery: a systematic review and meta-analysis of cohort studies

“…The studies were published between 2008 and 2021 involving a total of 7,571 participants. Twenty-one (65.6%) studies ( 18 - 20 , 24 , 26 - 31 , 33 - 37 , 40 , 41 , 45 - 47 , 49 ) were conducted in the European countries and 11 (34.4%) studies ( 17 , 25 , 32 , 38 , 39 , 42 - 44 , 48 , 50 , 51 ) in non-European countries. All studies sampled CHD patients from clinic-based population.…”