Biomarkers Predicting Postoperative Adverse Outcomes in Children with Congenital Heart Disease: a Systematic Review and Meta-analysis

Overview

Journal Front Pediatr

Date 2025 Feb 3

PMID 39896721

Authors

Shifan Zhou

Lu Liu

Xiaochuang Jin

Daniel Dorikun

Songfeng Ma

Affiliations

Soon will be listed here.

Abstract

Objective: To statistically analyze biomarkers predicting postoperative outcomes in children with congenital heart disease (CHD).

Methods: PubMed, Embase, Cochrane Library, and Web of Science were performed to search up to February 2024. The measured outcomes were biomarkers, mortality, length of hospital stay, complication rates, and infection rates. Adults with CHD were excluded. Standard deviation or odds ratio (OR) with 95% confidence interval (95% CI) were extracted. A random-effects model synthesized SMDs or ORs with 95% CIs. Sensitivity analysis investigated heterogeneity, and Egger's test assessed publication bias.

Results: Seventeen eligible articles were included, the biomarkers involved include serum lactate, NT-Pro BNP, PaO2, serum creatinine, C1-INH activity, ST2, serum chloride concentration, GH, glycemia, cTOI, NLR, serum albumin, and glucose levels, with 2,888 patients who underwent surgery(modified Norwood procedure, arterial switch procedure, biventricular repair etc.). Serum lactate was higher in the postoperative death group (SMD: 1.18, 95% CI: 0.59-1.77). Lower postoperative N-terminal pro-B-type natriuretic peptide (NT-pro BNP) levels were associated with lower mortality (OR: 0.23, 95% CI: 0.08-0.68) and shorter mechanical ventilation time (OR: 0.40, 95% CI: 0.18-0.90). Higher serum albumin levels were associated with longer hospital stays (OR: 3.12, 95% CI: 1.66-5.84). Significant heterogeneity was found in serum creatinine, B-type natriuretic peptide (BNP), serum lactate, and NT-Pro BNP. Publication bias was detected in some studies.

Conclusion: Serum lactate, NT-Pro BNP, and serum albumin are reliable biomarkers for predicting adverse outcomes in children with CHD after surgery.

Systematic Review Registration: PROSPERO [CRD42024512753].

References

Aly S, Zurakowski D, Glass P, Skurow-Todd K, Jonas R, Donofrio M . Cerebral tissue oxygenation index and lactate at 24 hours postoperative predict survival and neurodevelopmental outcome after neonatal cardiac surgery. Congenit Heart Dis. 2016; 12(2):188-195. DOI: 10.1111/chd.12426. View

Luo D, Wan X, Liu J, Tong T . Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res. 2016; 27(6):1785-1805. DOI: 10.1177/0962280216669183. View

Thomford N, Dzobo K, Yao N, Chimusa E, Evans J, Okai E . Genomics and Epigenomics of Congenital Heart Defects: Expert Review and Lessons Learned in Africa. OMICS. 2018; 22(5):301-321. PMC: 6016577. DOI: 10.1089/omi.2018.0033. View

Bouma B, Mulder B . Changing Landscape of Congenital Heart Disease. Circ Res. 2017; 120(6):908-922. DOI: 10.1161/CIRCRESAHA.116.309302. View

Lou S, Ding F, Long C, Liu J, Zhao J, Feng Z . Effects of peri-operative glucose levels on adverse outcomes in infants receiving open-heart surgery for congenital heart disease with cardiopulmonary bypass. Perfusion. 2010; 26(2):133-9. DOI: 10.1177/0267659110389843. View

Odek C, Kendirli T, Yildirim-Yildiz N, Yaman A, Ucar T, Eyileten Z . Perioperative factors associated with hyperglycemia after pediatric cardiac surgery and impact of hyperglycemia on morbidity and mortality. Turk J Pediatr. 2019; 60(5):497-505. DOI: 10.24953/turkjped.2018.05.005. View

van der Linde D, Konings E, Slager M, Witsenburg M, Helbing W, Takkenberg J . Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol. 2011; 58(21):2241-7. DOI: 10.1016/j.jacc.2011.08.025. View

Yang Q, Chen H, Correa A, Devine O, Mathews T, Honein M . Racial differences in infant mortality attributable to birth defects in the United States, 1989-2002. Birth Defects Res A Clin Mol Teratol. 2006; 76(10):706-13. DOI: 10.1002/bdra.20308. View

Maddhesiya J, Mohapatra B . Understanding the Genetic and Non-genetic Interconnections in the Aetiology of Isolated Congenital Heart Disease: An Updated Review: Part 1. Curr Cardiol Rep. 2024; 26(3):147-165. DOI: 10.1007/s11886-024-02022-9. View

10.

Baumgartner H, De Backer J, Babu-Narayan S, Budts W, Chessa M, Diller G . 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2020; 42(6):563-645. DOI: 10.1093/eurheartj/ehaa554. View

11.

Kimura S, Iwasaki T, Shimizu K, Kanazawa T, Kawase H, Shioji N . Hyperchloremia Is Not an Independent Risk Factor for Postoperative Acute Kidney Injury in Pediatric Cardiac Patients. J Cardiothorac Vasc Anesth. 2019; 33(7):1939-1945. DOI: 10.1053/j.jvca.2018.12.009. View

12.

Cao M, Liu Y, Sun Y, Han R, Jiang H . Current advances in human-induced pluripotent stem cell-based models and therapeutic approaches for congenital heart disease. Mol Cell Biochem. 2024; 480(1):159-172. DOI: 10.1007/s11010-024-04997-z. View

13.

Kwiatkowski D, Ball M, Savorgnan F, Allan C, Dearani J, Roth M . Neonatal Congenital Heart Disease Surgical Readiness and Timing. Pediatrics. 2022; 150(Suppl 2). DOI: 10.1542/peds.2022-056415D. View

14.

. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392(10159):1736-1788. PMC: 6227606. DOI: 10.1016/S0140-6736(18)32203-7. View

15.

Abella R, Satriano A, Frigiola A, Varrica A, Gavilanes A, Zimmermann L . Adrenomedullin alterations related to cardiopulmonary bypass in infants with low cardiac output syndrome. J Matern Fetal Neonatal Med. 2012; 25(12):2756-61. DOI: 10.3109/14767058.2012.718393. View

16.

Eindhoven J, van den Bosch A, Ruys T, Opic P, Cuypers J, McGhie J . N-terminal pro-B-type natriuretic peptide and its relationship with cardiac function in adults with congenital heart disease. J Am Coll Cardiol. 2013; 62(13):1203-12. DOI: 10.1016/j.jacc.2013.07.019. View

17.

Dabal R, Kirklin J, Kukreja M, Brown R, Cleveland D, Eddins M . The modern Fontan operation shows no increase in mortality out to 20 years: a new paradigm. J Thorac Cardiovasc Surg. 2014; 148(6):2517-23.e1. DOI: 10.1016/j.jtcvs.2014.07.075. View

18.

Tennant P, Pearce M, Bythell M, Rankin J . 20-year survival of children born with congenital anomalies: a population-based study. Lancet. 2010; 375(9715):649-56. DOI: 10.1016/S0140-6736(09)61922-X. View

19.

Parker D, Everett A, Stabler M, Vricella L, Jacobs M, Jacobs J . Biomarkers associated with 30-day readmission and mortality after pediatric congenital heart surgery. J Card Surg. 2019; 34(5):329-336. PMC: 6693333. DOI: 10.1111/jocs.14038. View

20.

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View