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

• Published in: PloS one Vol. 15; no. 7; p. e0236377
• Main Authors: Bobillo-Perez, Sara, Girona-Alarcon, Monica, Corniero, Patricia, Sole-Ribalta, Anna, Balaguer, Monica, Esteban, Elisabeth, Valls, Anna, Jordan, Iolanda, Cambra, Francisco Jose
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 23-07-2020; Public Library of Science (PLoS)
• Subjects: Adrenomedullin; Atrial natriuretic peptide; Biology and Life Sciences; Biomarkers; Cardiac arrhythmia; Children; Complications; Congestive heart failure; Heart diseases; Heart failure; Heart surgery; Intensive care; Laboratories; Medicine and Health Sciences; Mortality; Multivariate analysis; Patients; Pediatrics; Peptides; Postoperative period; Respiration; Sepsis; Surgery; Spain
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0236377

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 cut-off 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 outcome after cardiac surgery also had higher biomarker values (proADM, p = 0.013; proANP, p = 0.001). Conclusions Elevated proANP before cardiac surgery may identify which children will need more respiratory and inotropic support during the post-operative period.