High‐sensitive troponinT, interleukin‐8, and interleukin‐6 link with post‐surgery risk in infant heart surgery

• Published in: Acta anaesthesiologica Scandinavica 2024-07, Vol.68 (6), p.745-752
• Main Authors: Thorlacius, Elin M., Keski‐Nisula, Juho, Vistnes, Maria, Ojala, Tiina, Molin, Mattias, Synnergren, Mats, Romlin, Birgitta S., Ricksten, Sven‐Erik, Wåhlander, Håkan, Castellheim, Albert Gyllencreutz
• Format: Article
• Language: English
• Subjects: acute kidney injury; Acute Kidney Injury - blood; Acute Kidney Injury - etiology; Anestesi och intensivvård; Anesthesiology and Intensive Care; Biomarkers; Biomarkers - blood; Bypass; cardiac surgery; Cardiac Surgical Procedures; Cardiopulmonary Bypass - adverse effects; congenital heart defects; Cytokines; Double-Blind Method; Drugs; Female; Heart; Heart surgery; Humans; Infant; Infant, Newborn; Infants; Interleukin 6; Interleukin-6 - blood; Interleukin-8 - blood; Interleukins; Male; outcomes assessments; Patients; pediatric intensive care unit; Population studies; Postoperative Complications - blood; Postoperative Complications - epidemiology; Statistical analysis; Surgery; Troponin; Troponin T; Troponin T - blood; Vasoactive agents; Weaning
• ISSN: 0001-5172; 1399-6576; 1399-6576
• DOI: 10.1111/aas.14405

Background This study focuses on biomarkers in infants after open heart surgery, and examines the association of high‐sensitive troponin T (hs‐cTnT), interleukin‐6 (IL‐6), and interleukin‐8 (IL‐8) with postoperative acute kidney injury (AKI), ventilatory support time and need of vasoactive drugs. Methods Secondary exploratory study from a double‐blinded clinical randomized trial (Mile‐1) on 70 infants undergoing open heart surgery with cardiopulmonary bypass (CPB). In this sub‐study, the entire study population was examined without considering the study drugs. The biomarkers' peak concentration (highest concentration at 2 or 6 h post‐CPB) were used for statistical analyses. Results Peak IL‐8, hs‐cTnT, and IL‐6 occurred at 2 h post‐CPB for 96%, 79%, and 63% of the patients, respectively. The odds ratio of developing AKI2‐3 for IL‐6 > 293 pg/mL was 23.4 (95% CI 5.3;104.0), for IL‐8 > 100 pg/mL it was 11.5 (3.0;44.2), and for hs‐cTnT >5597 pg/mL it was 6.1 (1.5; 24.5). In more than two third of the patients with the highest peak concentrations of IL‐8, IL‐6, and hs‐cTnT, there was a need for ventilatory support for >24 h and use of vasoactive drugs at 24 h post‐CPB, while in less than one third of the patients with the lowest peak concentrations of IL‐8 and hs‐cTnT such requirements were observed. Conclusions The peak biomarker concentrations and CPB‐time strongly predicted AKI2‐3, with IL‐6 and IL‐8 emerging as strongest predictors. Furthermore, our findings suggest that measuring hs‐cTnT and IL‐8 just 2 h post‐CPB‐weaning may assist in identifying infants suitable for early extubation and highlight those at risk of prolonged ventilation.