Syndecan-1 as a Biomarker for Fluid Overload After High-Risk Pediatric Cardiac Surgery: A Pilot Study

Area of Science:

• Cardiovascular Surgery
• Pediatric Critical Care
• Biomarker Discovery

Background:

• Fluid overload (FO) is a common complication following pediatric cardiac surgery with cardiopulmonary bypass (CPB).
• FO is associated with adverse patient outcomes.
• Endothelial glycocalyx injury, indicated by syndecan-1 (SD1) levels, may play a role in FO.

Purpose of the Study:

• To investigate the relationship between plasma syndecan-1 (SD1) concentrations and fluid overload (FO).
• To assess SD1 as a potential biomarker for FO in pediatric patients undergoing cardiac surgery with CPB.

Main Methods:

• Prospective observational pilot study conducted in a pediatric cardiac intensive care unit.
• Enrolled 15 pediatric patients undergoing high-risk cardiac surgery with CPB.
• Measured plasma SD1 concentrations preoperatively and postoperatively, comparing them with fluid balance on various postoperative days.

Main Results:

• Plasma SD1 levels effectively discriminated fluid balance >= 10% on postoperative days 1, 2, and 3 (AUROC 0.74-0.88).
• SD1 also discriminated peak fluid balance >= 10% over the first seven postoperative days (AUROC 0.94).
• Elevated delta SD1 was significantly associated with >= 10% fluid balance and adverse events like prolonged mechanical ventilation.

Conclusions:

• Plasma SD1 is associated with fluid overload in pediatric patients after cardiac surgery with CPB.
• SD1 shows promise as a biomarker for identifying FO in this patient population.
• Further research is warranted to explore the clinical utility of SD1 in managing pediatric cardiac surgery patients.