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

• Published in: The journal of maternal-fetal & neonatal medicine 2012-12, Vol.25 (12), p.2756-2761
• Main Authors: Abella, Raul, Satriano, Angela, Frigiola, Alessandro, Varrica, Alessandro, Gavilanes, Antonio DW, Zimmermann, Luc J, Vles, Hans JS, Florio, Pasquale, Calevo, Maria Grazia, Gazzolo, Diego
• Format: Article
• Language: English
• Subjects: Adrenomedullin; Adrenomedullin - analysis; Adrenomedullin - blood; Age Factors; Cardiac Output, Low - blood; Cardiac Output, Low - diagnosis; Cardiac Output, Low - epidemiology; Cardiac Output, Low - etiology; cardiopulmonary bypass; Cardiopulmonary Bypass - adverse effects; Cardiopulmonary Bypass - statistics & numerical data; Case-Control Studies; Female; Heart Defects, Congenital - blood; Heart Defects, Congenital - diagnosis; Heart Defects, Congenital - epidemiology; Heart Defects, Congenital - surgery; Humans; Infant; Infant, Newborn; Male; newborn; Postoperative Complications - blood; Postoperative Complications - congenital; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Prognosis; Sensitivity and Specificity
• ISSN: 1476-7058; 1476-4954
• DOI: 10.3109/14767058.2012.718393

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.