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Biomarkers improve prediction of 30-day unplanned readmission or mortality after paediatric congenital heart surgery

Published online by Cambridge University Press:  10 July 2019

Jeremiah R. Brown
Affiliation:
Department of Epidemiology, Geisel School of Medicine, Lebanon, NH, USA Department of Biomedical Data Science, Geisel School of Medicine, Hanover, NH, USA The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Hanover, NH, USA
Meagan E. Stabler
Affiliation:
Department of Epidemiology, Geisel School of Medicine, Lebanon, NH, USA
Devin M. Parker
Affiliation:
Department of Epidemiology, Geisel School of Medicine, Lebanon, NH, USA
Luca Vricella
Affiliation:
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Sara Pasquali
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA
JoAnna K. Leyenaar
Affiliation:
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Hanover, NH, USA Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
Andrew R. Bohm
Affiliation:
Department of Epidemiology, Geisel School of Medicine, Lebanon, NH, USA
Todd MacKenzie
Affiliation:
Department of Epidemiology, Geisel School of Medicine, Lebanon, NH, USA Department of Biomedical Data Science, Geisel School of Medicine, Hanover, NH, USA The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Hanover, NH, USA
Chirag Parikh
Affiliation:
Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
Marshall L. Jacobs
Affiliation:
Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children’s Heart Institute, Johns Hopkins All Children’s Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, FL, USA Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Jeffrey P. Jacobs
Affiliation:
Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children’s Heart Institute, Johns Hopkins All Children’s Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, FL, USA Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Allen D. Everett
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Corresponding
E-mail address:

Abstract

Objective:

To evaluate the association between novel pre- and post-operative biomarker levels and 30-day unplanned readmission or mortality after paediatric congenital heart surgery.

Methods:

Children aged 18 years or younger undergoing congenital heart surgery (n = 162) at Johns Hopkins Hospital from 2010 to 2014 were enrolled in the prospective cohort. Collected novel pre- and post-operative biomarkers include soluble suppression of tumorgenicity 2, galectin-3, N-terminal prohormone of brain natriuretic peptide, and glial fibrillary acidic protein. A model based on clinical variables from the Society of Thoracic Surgery database was developed and evaluated against two augmented models.

Results:

Unplanned readmission or mortality within 30 days of cardiac surgery occurred among 21 (13%) children. The clinical model augmented with pre-operative biomarkers demonstrated a statistically significant improvement over the clinical model alone with a receiver-operating characteristics curve of 0.754 (95% confidence interval: 0.65–0.86) compared to 0.617 (95% confidence interval: 0.47–0.76; p-value: 0.012). The clinical model augmented with pre- and post-operative biomarkers demonstrated a significant improvement over the clinical model alone, with a receiver-operating characteristics curve of 0.802 (95% confidence interval: 0.72–0.89; p-value: 0.003).

Conclusions:

Novel biomarkers add significant predictive value when assessing the likelihood of unplanned readmission or mortality after paediatric congenital heart surgery. Further exploration of the utility of these novel biomarkers during the pre- or post-operative period to identify early risk of mortality or readmission will aid in determining the clinical utility and application of these biomarkers into routine risk assessment.

Type
Original Article
Copyright
© Cambridge University Press 2019 

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