Perioperative Brain Natriuretic Peptide in Pediatric Cardiac Surgery Patients: Its Association With Postoperative Outcomes

Objectives The aim of this study was to investigate the relationship between perioperative brain natriuretic peptide levels and the incidence of postoperative serious adverse events (SAEs) in pediatric cardiac patients. Design A prospective observational study. Setting A single-institution university hospital. Participants Children under 15 years old who underwent cardiac surgery that required cardiopulmonary bypass from December 21, 2012 to February 26, 2014. The Risk Adjustment for Congenital Heart Surgery 1 category less than 1 was excluded. Interventions Brain natriuretic peptide (BNP) levels were measured preoperatively (BNP_pre) and on postoperative day 1 (BNP_POD1) and postoperative day 3 (BNP_POD3). Methods and Results Primary outcome was the incidence of postoperative SAEs; (1) death in the intensive care unit, (2) requirement of extracorporeal membrane oxygenation, (3) cardiac arrest, and (4) requirement of reoperation for hemodynamic instability. The authors included 71 patients in this study. There were 8 patients (11%) who had at least 1 SAE. Median preoperative BNP level in patients with SAEs was significantly higher than in those without SAEs (1,541 pg/mL [IQR: 121-5,962] v 122 pg/mL [QR: 34-342], p = 0.01). From the receiver operating characteristic curve of BNP_pre for the incidence of SAEs, an area under the curve was 0.77 (95%CI 0.55-0.91). The best cutoff BNP_pre number was 1,000 pg/mL. From the multivariate logistic regression model, BNP_pre>1,000 pg/mL was associated independently with risk of SAEs (adjusted odds ratio = 8.5, 95% CI [1.3, 59.3], p = 0.02). Conclusions In conclusion, the authors’ study showed that increased preoperative brain natriuretic peptide concentration, especially a concentration of more than 1,000 pg/mL, was associated with risk of SAEs in pediatric cardiac surgery patients.