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Published on: May 26, 2023
Predictors of Ominous Outcome in Infants Undergone to Cardiac Surgery and Cardiopulmonary by-Pass: S100B Protein
A Varrica, A Satriano, G Tettamanti
1Department of Maternal Fetal and Neonatal Medicine, C. Arrigo Children's Hospital, Spalto Marengo 46 I-15100 Alessandria, Italy. dgazzolo@hotmail.com.
Insights
S100B protein levels can predict early death in newborns with congenital heart disease (CHD). Higher S100B concentrations before surgery indicate a higher risk of perioperative death in these infants.
Area of Science:
- Biochemistry
- Pediatric Cardiology
- Neurology
Background:
- S100B protein is a recognized marker for brain damage and mortality in various patient groups.
- Congenital heart disease (CHD) poses significant risks for perioperative complications, including early death, in newborns.
- Identifying reliable biomarkers for predicting adverse outcomes in CHD infants is crucial for timely intervention.
Purpose of the Study:
- To investigate the utility of longitudinal S100B protein measurements in predicting perioperative early death in newborns with CHD.
- To assess the pattern of S100B protein concentration changes during the perioperative period in CHD infants.
- To determine if S100B levels can serve as an early warning indicator for mortality in this vulnerable population.
Main Methods:
- A case-control study involving 88 infants with CHD, including 22 who experienced perioperative death within the first week after surgery.
- Blood samples were collected at five time-points: preoperatively, intraoperatively (during cardiopulmonary bypass and at the end of surgery), and postoperatively (up to 24 hours).
- S100B protein concentrations were measured, and Receiver Operating Characteristic (ROC) curve analysis was performed to evaluate predictive accuracy.
Main Results:
- S100B protein levels significantly increased from admission, peaking during cardiopulmonary bypass and at the end of surgery in all CHD infants (P<0.01).
- Infants who died perioperatively exhibited significantly higher S100B concentrations at all monitoring time-points compared to controls (P<0.01).
- S100B measured preoperatively was the strongest predictor of perioperative death, with a cut-off of 0.1 μg/L achieving 100% sensitivity and 63.7% specificity.
Conclusions:
- Longitudinal monitoring of S100B protein is feasible in the perioperative period for CHD infants.
- Elevated S100B levels, particularly preoperatively, are strongly associated with an increased risk of early death in newborns undergoing CHD surgery.
- S100B protein shows promise as a valuable biomarker for adverse outcome prediction in the perioperative management of congenital heart disease.
Abstract:
S100B protein has been recently proposed as a consolidated marker of brain damage and death in adult, children and newborn patients. The present study evaluates whether the longitudinal measurement of S100B at different perioperative time-points may be a useful tool to identify the occurrence of perioperative early death in congenital heart disease (CHD) newborns. We conducted a case-control study in 88 CHD infants, without pre-existing neurological disorders or other co-morbidities, of whom 22 were complicated by perioperative death in the first week from surgery. Control group was composed by 66 uncomplicated CHD infants matched for age at surgical procedure. Blood samples were drawn at five predetermined time-points before during and after surgery. In all CHD children, S100B values showed a pattern characterized by a significant increase in protein's concentration from hospital admission up to 24-h after procedure reaching their maximum peak (P<0.01) during cardiopulmonary by-pass and at the end of the surgical procedure. Moreover, S100B concentrations in CHD death group were significantly higher (P<0.01) than controls at all monitoring time-points. The ROC curve analysis showed that S100B measured before surgical procedure was the best predictor of perioperative death, among a series of clinical and laboratory parameters, reaching at a cut-off of 0.1 μg/L a sensitivity of 100% and a specificity of 63.7%. The present data suggest that in CHD infants biochemical monitoring in the perioperative period is becoming possible and S100B can be include among a series of parameters for adverse outcome prediction.
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