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Selected Publication:
Preiß, S.
The role of modern biomarkers in the postoperative intensive care of pediatric patients after cardiac surgery
[ Diplomarbeit ] Medical University of Graz; 2013. pp. 90
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- Authors Med Uni Graz:
- Advisor:
- Zobel Gerfried
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- Abstract:
- Objectives: One basic principle of pediatric intensive care is the constant monitoring of vital- and laboratory parameters in order to recognize deteriorations of a patient¿s status early and take appropriate measures. In the past the focus of interest mainly lay in physical monitoring whereas recently the focus has shifted towards ¿new¿ laboratory parameters. In various studies it has been proved that beside classical inflammatory markers like white blood cell count and C-reactive protein (CRP) also these ¿new¿ biomarkers like procalcitonin (PCT), interleukin-6 (IL-6), interleukin-10 (IL-10), troponin T (TnT) and N-terminal pro brain natriuretic peptide (NT-proBNP) can provide essential information during the post-operative period. The aim of this study is to investigate the correlation of the above mentioned biomarkers with parameter of outcome, inflammation, haemodynamics and respiration in order to be able to predict the further course of a pediatric patient¿s status after cardiosurgical interventions. Material and Methods: The project was designed as a retrospective study of the years 2010 to 2012. The data were collected at the pediatric intensive care unit (PICU) of the University Hospital of Graz. All children and adolescents with congenital heart disease who underwent cardiac surgery, including re-operations, and who were transferred from the operating theatre to the ICU were included. The total number of included patients was 172 and the sex was overall well balanced. In the first step we looked for a correlation of the five biomarkers (procalcitonin, interleukin-6, interleukin-10, troponin T, N-terminal pro brain natriuretic peptide) with parameters of outcome (length of mechanical ventilation, length of pediatric intensive care unit stay, length of hospital stay) and with operation-specific data (length of cardiopulmonary bypass and aortic cross-clamping time). In the second step we looked for a correlation of the five biomarkers with parameters of inflammation (white blood cell count, C-reactive protein, central body temperature) and hemodynamics (ejection fraction, fractional shortening, stroke volume, cardiac index, velocity time integral, tricuspid annular plane systolic excursion, central venous oxygen saturation, vasoactive-inotropic score, difference of the venous and the arterial carbon dioxide, lactate, difference of central and peripheral temperature). In the third step we looked for a correlation of the biomarkers among each other. In the fourth and last step we looked for a correlation of the height of the heart-specific biomarkers with age and the type of heart disease. Results: IL-6 and IL-10 levels showed poor, PCT levels moderate and TnT and NT-proBNP levels good correlations with the tested parameters. TnT levels showed a correlation with different diagnosis subgroups, NT-proBNP levels showed a correlation with age groups. Conclusion: TnT and NT-proBNP were the most promising of the investigated biomarkers and showed the best correlation with parameters of outcome, inflammation, hemodynamics and respiration. IL-6 and IL-10 showed poor correlations with the tested parameters. All in all, we conclude that one single test of any biomarker is unable to predict the further course and the prognosis of any patient.