Pediatric Critical Care Medicine Fellow University of Alabama at Birmingham Birmingham, Alabama, United States
Abstract: INTRODUCTION Tetranectin (TN) is a protein that plays a role in tissue remodeling. In heart failure, serum TN has a better prognostic value compared to B-type natriuretic peptide (BNP) in adults. We aimed to examine the behavior of TN in neonates following the Norwood operation. We explored its prognostic value and association with multiple clinical and laboratory indices.
METHODS The Children’s of Alabama Pediatric Cardiac Biorepository houses samples from patients who receive congenital heart disease repair at our center. The biorepository was screened for serum samples from neonates who underwent the Norwood procedure for inclusion. Patients needing inotropic support or mechanical circulatory support preoperatively were excluded. 26 patients met eligibility criteria. TN and BNP levels were measured by ELISA at 5 different time points - pre-cardiopulmonary bypass (CPB), 0 hour, 4 hours, 24 hours, and 48 hours following CPB. The primary outcome was time to lactate clearance and duration of inotropic support.
RESULTS Survival Weibull regression analyses were performed for the two primary outcomes for all subjects. Univariate analysis showed that higher TN levels a 0 and 4 hours was associated with a longer duration of inotropic support. This was consistent after adjusting for BNP levels in a multivariable analysis (Table 1). Patients were also stratified based on duration of inotropic support and divided into tertiles. Logistic regression analyses were performed on the upper (n=9) and lower tertiles (n=9) and the trend in TN levels compared between the two tertiles shows a higher trend in TN levels in patients with longer duration of inotropic support (Figure 1). Logistic regression analyses comparing TN levels at different time points with duration of inotropic support showed TN level at 4 hours post CPB was a significant predictor (p value- 0.0382) for a longer duration of inotropic support with an AUC of 0.876. No significant association was found between TN and BNP levels for time to lactate clearance.
CONCLUSION Following the Norwood operation, higher levels of serum TN was found to predict a longer duration of inotropic support, suggesting its ability to predict the short-term post-operative course, especially at 4 hours following surgery. Larger prospective studies are needed to confirm and validate TN as an important biomarker in these patients.
