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Prognostic role of BNP in children undergoing surgery for congenital heart disease: analysis of prediction models incorporating standard risk factors

  • Massimiliano Cantinotti , Raffaele Giordano EMAIL logo , Marco Scalese , Sabrina Molinaro , Francesca della Pina , Simona Storti , Luigi Arcieri , Bruno Murzi , Marco Marotta , Vitali Pak , Vincenzo Poli , Giorgio Iervasi , Shelby Kutty and Aldo Clerico
Published/Copyright: April 22, 2015
Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 53 Issue 11

Abstract

Background: The routine use of brain natriuretic peptide (BNP) in pediatric cardiac surgery remains controversial. Our aim was to test whether BNP adds information to predict risk in pediatric cardiac surgery.

Methods: In all, 587 children undergoing cardiac surgery (median age 6.3 months; 1.2–35.9 months) were prospectively enrolled at a single institution. BNP was measured pre-operatively, on every post-operative day in the intensive care unit, and before discharge. The primary outcome was major complications and length ventilator stay >15 days. A first risk prediction model was fitted using Cox proportional hazards model with age, body surface area and Aristotle score as continuous predictors. A second model was built adding cardiopulmonary bypass time and arterial lactate at the end of operation to the first model. Then, peak post-operative log-BNP was added to both models. Analysis to test discrimination, calibration, and reclassification were performed.

Results: BNP increased after surgery (p<0.001), peaking at a mean of 63.7 h (median 36 h, interquartile range 12–84 h) post-operatively and decreased thereafter. The hazard ratios (HR) for peak-BNP were highly significant (first model HR=1.40, p=0.006, second model HR=1.44, p=0.008), and the log-likelihood improved with the addition of BNP at 12 h (p=0.006; p=0.009). The adjunction of peak-BNP significantly improved the area under the ROC curve (first model p<0.001; second model p<0.001). The adjunction of peak-BNP also resulted in a net gain in reclassification proportion (first model NRI=0.089, p<0.001; second model NRI=0.139, p=0.003).

Conclusions: Our data indicates that BNP may improve the risk prediction in pediatric cardiac surgery, supporting its routine use in this setting.

Keywords: brain natriuretic peptide (BNP); congenital heart disease; pediatric cardiac surgery
Corresponding author: Raffaele Giordano, MD, Tuscany Foundation “G. Monasterio”, Pediatric Cardiology and Cardiac Surgery, 54100 Massa, Italy, Phone: +39 0585493622, Fax: +39 0585493616, E-mail:

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Supplemental Material

The online version of this article (DOI: 10.1515/cclm-2014-1084) offers supplementary material, available to authorized users.

Received: 2014-11-4
Accepted: 2015-3-17
Published Online: 2015-4-22
Published in Print: 2015-10-1

©2015 by De Gruyter

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https://doi.org/10.1515/cclm-2014-1084
Keywords for this article
brain natriuretic peptide (BNP); congenital heart disease; pediatric cardiac surgery

Articles in the same Issue

  1. Frontmatter
  2. Editorials
  3. Laboratory medicine does matter in science (and medicine)… yet many seem to ignore it
  4. The standardization of the urine albumin assays: no longer deferrable
  5. Reviews
  6. The role of telomeres and vitamin D in cellular aging and age-related diseases
  7. Atypical hemolytic uremic syndrome: from diagnosis to treatment
  8. Clinical relevance and contemporary methods for counting blood cells in body fluids suspected of inflammatory disease
  9. EFLM Opinion Paper
  10. How to assess the quality of your analytical method?
  11. Genetics and Molecular Diagnostics
  12. Validation of CFTR intronic variants identified during cystic fibrosis population screening by a minigene splicing assay
  13. General Clinical Chemistry and Laboratory Medicine
  14. Uncertainty in measurement for 43 biochemistry, immunoassay, and hemostasis routine analytes evaluated by a method using only external quality assessment data
  15. A study examining the bias of albumin and albumin/creatinine ratio measurements in urine
  16. National survey on appropriateness of clinical biochemistry reporting in China
  17. Potentiometric measurement of urinary iodine concentration in patients with thyroid diseases with and without previous exposure to non-radioactive iodine
  18. Determination of 21-hydroxylase autoantibodies: inter-laboratory concordance in the Euradrenal International Serum Exchange Program
  19. Value of a commercial kit for detecting anti-C1q autoantibodies and correlation with immunological and clinical activity of lupus nephritis
  20. Comparison of the bead-based simultaneous analysis of specific platelet antibodies assay (SASPA) and Pak Lx Luminex technology with the monoclonal antibody immobilization of platelet antigens assay (MAIPA) to detect platelet alloantibodies
  21. Measurement of the inflammatory response in the early postoperative period after hip and knee arthroplasty
  22. Whole blood thromboelastometry profiles in women with preeclampsia
  23. Increased plasma soluble urokinase plasminogen activator receptor levels in systemic sclerosis: possible association with microvascular abnormalities and extent of fibrosis
  24. Reference Values and Biological Variations
  25. Reference ranges of serum bile acids in children and adolescents
  26. Infectious Diseases
  27. Elevated circulating ghrelin, but not peptide YY(3-36) levels, in term neonates with infection
  28. Cardiovascular Diseases
  29. Head-to-head comparison of 10 natriuretic peptide assays
  30. Prognostic role of BNP in children undergoing surgery for congenital heart disease: analysis of prediction models incorporating standard risk factors
  31. Elevations of inflammatory markers PTX3 and sST2 after resuscitation from cardiac arrest are associated with multiple organ dysfunction syndrome and early death
  32. Identification of molecular species of oxidized triglyceride in plasma and its distribution in lipoproteins
  33. A new formula for estimation of low-density lipoprotein cholesterol in an ethnic Chinese population
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  44. Comparison of nucleated red blood cell count with four commercial hematological analyzers
  45. Reply to: The risk of macrovascular complications in subjects genotyped for common IL-6 gene and TNF-α gene variants
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  47. Congress of Clinical Chemistry and Laboratory Medicine
  48. 47th National Congress of the Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC – Laboratory Medicine)
  49. 15th EFLM Continuous Postgraduate Course in Clinical Chemistry and Laboratory Medicine
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