Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2013.10.006
Brazilian Journal of Anesthesiology
Scientific Article

The predictive value of plasma B-type natriuretic peptide levels on outcome in children with pulmonary hypertension undergoing congenital heart surgery

O valor preditivo do peptídeo natriurético tipo-B em resultados de crianças com hipertensão pulmonar submetidas à cirurgia cardíaca congênita

Ayse Baysal; Ahmet SŞ; ; mazel; Ayse Yildirim; Buket Ozyaprak; Narin Gundogus; Tuncer Kocak

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Abstract

Background and objectives:In children undergoing congenital heart surgery, plasma brain natriuretic peptide levels may have a role in development of low cardiac output syndrome that is defined as a combination of clinical findings and interventions to augment cardiac output in children with pulmonary hypertension.Methods:In a prospective observational study, fifty-one children undergoing congenital heart surgery with preoperative echocardiographic study showing pulmonary hypertension were enrolled. The plasma brain natriuretic peptide levels were collected before operation, 12, 24 and 48 h after operation. The patients enrolled into the study were divided into two groups depending on: (1) Development of LCOS which is defined as a combination of clinical findings or interventions to augment cardiac output postoperatively; (2) Determination of preoperative brain natriuretic peptide cut-off value by receiver operating curve analysis for low cardiac output syndrome. The secondary end points were: (1) duration of mechanical ventilation ≥72 h, (2) intensive care unit stay >7days, and (3) mortality.Results:The differences in preoperative and postoperative brain natriuretic peptide levels of patients with or without low cardiac output syndrome (n = 35, n = 16, respectively) showed significant differences in repeated measurement time points (p = 0.0001). The preoperative brain natriuretic peptide cut-off value of 125.5 pg mL−1 was found to have the highest sensitivity of 88.9% and specificity of 96.9% in predicting low cardiac output syndrome in patients with pulmonary hypertension. A good correlation was found between preoperative plasma brain natriuretic peptide level and duration of mechanical ventilation (r = 0.67, p = 0.0001).Conclusions:In patients with pulmonary hypertension undergoing congenital heart surgery, 91% of patients with preoperative plasma brain natriuretic peptide levels above 125.5 pg mL−1 are at risk of developing low cardiac output syndrome which is an important postoperative outcome.

Keywords

Pediatrics, Congenital heart defects, Cardiopulmonary bypass, B-type natriuretic peptide, Outcome, Postoperative

Resumo

Justificativa e objetivo:Em crianças submetidas à cirurgia cardíaca congênita, os níveis plasmáticos de peptídeo natriurético cerebral (PNC) podem ter um papel no desenvolvimento da síndrome de baixo débito cardíaco (SBDC), definida como uma combinação de achados clínicos e intervenções para aumentar o débito cardíaco em crianças com hipertensão pulmonar.Métodos:Em um estudo prospectivo observacional, foram inscritas 51 crianças submetidas à cirurgia cardíaca congênita, com avaliação ecocardiográfica pré-operatória que mostrava hipertensão pulmonar. Os níveis plasmáticos de PNC foram avaliados antes e 12, 24 e 48 h após a operação. Os pacientes incluídos no estudo foram divididos em dois grupos em função de: (1) desenvolvimento de SBDC; (2) determinação dos valores de corte de PNC no pré-operatório pela análise da curva de funcionamento do receptor para SBDC. Os desfechos secundários foram: (1) duração da ventilação mecânica ≥ 72 h, (2) permanência em unidade de terapia intensiva > 7 dias e (3) mortalidade.Resultados:Os níveis de PNC nos períodos pré- e pós-operatório dos pacientes com ou sem SBDC (n = 35, n = 16, respectivamente) apresentaram diferenças significantes nos tempos de mensuração repetidos (p = 0,0001). O valor de corte de PNC de 125,5 pg mL−1 no pré-operatório obteve a maior sensibilidade de 88,9% e especificidade de 96,9% para prever a SBDC em pacientes com hipertensão pulmonar. Uma boa correlação foi descoberta entre o nível plasmático de PNC no pré-operatório e duração a ventilação mecânica (r = 0,67, p = 0,0001).Conclusões:Em pacientes com hipertensão pulmonar submetidos à cirurgia cardíaca congênita, 91% com níveis plasmáticos de PNC acima de 125,5 pg mL−1 no período pré-operatório estão em risco de desenvolver a SBDC, que é um desfecho importante no pós-operatório.

Palavras-chave

Pediatria, Cardiopatias congênitas, Circulação extracorpórea, Peptídeo natriurético tipo-B, Desfecho, Pós-operatório

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