Abstract 17097: A Novel Brain Injury Biomarker Correlates With Cyanosis in Infants With Congenital Heart Disease
Introduction: Cyanotic heart lesions are a complex subset of congenital heart disease (CHD) in which patients are persistently desaturated until surgical repair/palliation.
Hypothesis: We hypothesized there will be a direct relationship between degree of preoperative desaturation and presence of systemic inflammation, as well as evidence of brain injury in children less than one year of age. We further hypothesized that preoperative desaturation with augmented systemic inflammation will predict a more complex postoperative course.
Methods: Fifty patients with CHD were enrolled in this study and classified as cyanotic (O2 ≤90%) or acyanotic (O2>90%) based on SpO2. Serum was obtained within 2 weeks of the cardiac surgery and the following inflammatory mediators were analyzed using commercially available ELISA kits: macrophage migration inhibitory factor, IL-6, IL-8, TNF-α, IL-12p70, IL-10, IL-1β, and INF-γ; and a novel biomarker of axonal injury, phosphorylated high-molecular weight neurofilament (pNF-H). Postoperative variables included inotrope score, duration of mechanical ventilation and length of stay.
Results: A total of 22 cyanotic and 28 acyanotic patients were enrolled with a median age of 9.5 days (range 2-303 days) and 99.5 days (range 1-274 days), respectively; and a mean ± SD SpO2 of 78 ± 18% and 97 ± 3% (p<0.001), respectively. Compared to acyanotic patients, cyanotic patients had significantly elevated IL-6 (6.6 ± 7.6 vs 2.9 ± 2.9 pg/ml, p=0.019) and pNF-H (222 ± 637 vs 57 ± 121 pg/ml, p=0.046) preoperatively, and both biomarkers were associated with the degree of desaturation (Spearman correlation ρ=-0.30, p=0.037 and ρ=-0.29, p=0.049, respectively). Cyanotic patients had higher inotrope scores at 24 and 48 hours (p=0.022 and p=0.047, respectively) and the preoperative oxygen saturation was inversely related to duration of mechanical ventilation postoperatively (ρ=-0.4, p=0.02).
Conclusions: Cyanotic patients with CHD were exposed to higher serum concentrations of inflammatory mediators in the preoperative period compared to acyanotic patients, and showed evidence of brain injury. The severity of preoperative desaturation was a significant predictor of greater postoperative medical intervention.
- Congenital heart disease
- Congenital heart surgery, pediatric
- Inflammation and inflammatory markers
Author Disclosures: L. McPhillips: None. K. Ojamaa: None. C. Sison: None. D. Gruber: None. D. Kholwadwala: None.
- © 2016 by American Heart Association, Inc.