Evaluation of the vasoactive-inotropic score, mid-regional pro-adrenomedullin and cardiac troponin I as predictors of low cardiac output syndrome in children after congenital heart disease surgery
| Autor: | Mercedes Gil-Campos, S. Jaraba-Caballero, Carlos Merino-Cejas, Juan Luis Pérez-Navero, M.J. de la Torre-Aguilar, Elena Gómez-Guzmán, I. Ibarra de la Rosa, M.A. Frías-Pérez |
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| Rok vydání: | 2019 |
| Předmět: |
Heart Defects
Congenital Male Inotrope medicine.medical_specialty Cardiotonic Agents Multivariate analysis Adolescent Heart disease Cardiac Output Low Critical Care and Intensive Care Medicine Logistic regression law.invention Adrenomedullin Postoperative Complications Predictive Value of Tests law Statistical significance Cardiopulmonary bypass medicine Humans Prospective Studies Protein Precursors Child Cardiopulmonary Bypass business.industry Troponin I Infant Cardiovascular Agents medicine.disease Peptide Fragments Surgery surgical procedures operative Low cardiac output syndrome Child Preschool Female Observational study business |
| Zdroj: | Medicina Intensiva. 43:329-336 |
| ISSN: | 0210-5691 |
| Popis: | Objective To determine the predictive value of the inotropic score (IS) and vasoactive-inotropic score (VIS) in low cardiac output syndrome (LCOS) in children after congenital heart disease surgery involving cardiopulmonary bypass (CPB), and to establish whether mid-regional pro-adrenomedullin (MR-proADM) and cardiac troponin I (cTn-I), associated to the IS and VIS scores, increases the predictive capacity in LCOS. Design A prospective observational study was carried out. Setting A Paediatric Intensive Care Unit. Patients A total of 117children with congenital heart disease underwent CPB. Patients were divided into two groups: LCOS and non-LCOS. Interventions The clinical and analytical data were recorded at 2, 12, 24 and 48 h post-CPB. Logistic regression was used to develop a risk prediction model using LCOS as dependent variable. Main outcome measures LCOS, IS, VIS, MR-proADM, cTn-I, age, sex, CPB time, PIM-2, Aristotle score. Results While statistical significance was not recorded for IS in the multivariate analysis, VIS was seen to be independently associated to LCOS. On the other hand, VIS > 15.5 at 2 h post-CPB, adjusted for age and CPB timepoints, showed high specificity (92.87%; 95%CI: 86.75–98.96) and increased negative predictive value (75.59%, 95%CI: 71.1–88.08) for the diagnosis of LCOS at 48 h post-CPB. The predictive power for LCOS did not increase when VIS was combined with cTn-I >14 ng/ml at 2 h and MR-proADM >1.5 nmol/l at 24 h post-CPB. Conclusions The VIS score at 2 h post-CPB was identified as an independent early predictor of LCOS. This predictive value was not increased when associated with LCOS cardiac biomarkers. The VIS score was more useful than IS post-CPB in making early therapeutic decisions in clinical practice post-CPB. |
| Databáze: | OpenAIRE |
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