Adrenomedullin alterations related to cardiopulmonary bypass in infants with low cardiac output syndrome

Abstract

Background: Low cardiac output syndrome (LCOS) remains a major perioperative complications in infants subjected to open-heart surgery with cardiopulmonary bypass (CPB). The present study investigated whether perioperative blood assessment of a potent vasoactive peptide namely adrenomedullin (AM) can predict the risk of LCOS. Methods: We measured AM levels in 48 patients (LCOS: n = 9; controls: n = 39) undergone to open-heart surgery with CPB at five predetermined time points before, during and after the surgery. Clinical, laboratory and perioperative data were analyzed by a multiple logistic regression model. Results: AM significantly decreased (p < 0.01) during and after the surgical procedure exhibiting a dip at the end of the CPB. Multivariable analysis demonstrated significant correlations among LCOS, AM measured at the end of CPB (p < 0.001), and cooling duration (p < 0.05). AM at 27 pg/L cutoff achieved a sensitivity of 100% and a specificity of 64.1%, while cooling at 11-min cutoff combined a sensitivity of 55.6% and a specificity of 92.3% for LCOS prediction. Conclusions: This study suggests that AM can constitute, alone or combined with standard parameters, a promising predictor of LCOS in infants subjected to open-heart surgery with CPB.

Keywords::

• Adrenomedullin
• cardiopulmonary bypass
• newborn

Acknowledgements

We want to thank Anna Capurro for her support in English language preparation of the manuscript.

Declaration of Interest: This work takes part to the I.O. PhD International Program and was partially supported by grants to DG from Stella Cometa, Let’s Improve Perinatal Life Foundations, Italy. The funding sources had no role in the study design, data collection, data interpretation, data analysis, or writing of this manuscript.