Key result
PERSEVERE-CPB model predicts persistent MODS after pediatric cardiac surgery with an AUROC of 0.86.
Why the study?
Multiple organ dysfunction syndrome causes significant morbidity and mortality after congenital heart surgery requiring cardiopulmonary bypass, but whether PERSEVERE biomarkers and clinical data could predict persistent post-bypass organ dysfunction was unknown.
Does a biomarker-based risk model combining IL-8, CCL3, and age predict persistent multiple organ dysfunction syndrome in pediatric patients after congenital heart surgery requiring cardiopulmonary bypass?
Cohort (n=306)
No
Does a biomarker-based risk model combining IL-8, CCL3, and age predict persistent multiple organ dysfunction syndrome in pediatric patients after congenital heart surgery requiring cardiopulmonary bypass?
Effect estimate: AUROC 0.86 (95% CI 0.81-0.91)
A novel risk prediction model combining IL-8, CCL3, and age accurately predicts the development of persistent multiple organ dysfunction after pediatric cardiac surgery requiring cardiopulmonary bypass.
May aid postoperative risk stratification after pediatric CPB; leaves open prospective validation before clinical adoption.
Background: Multiple organ dysfunction syndrome (MODS) is an important cause of post-operative morbidity and mortality for children undergoing cardiac surgery requiring cardiopulmonary bypass (CPB). Dysregulated inflammation is widely regarded as a key contributor to bypass-related MODS pathobiology, with considerable overlap of pathways associated with septic shock. The pediatric sepsis biomarker risk model (PERSEVERE) is comprised of seven protein biomarkers of inflammation, and reliably predicts baseline risk of mortality and organ dysfunction among critically ill children with septic shock. We aimed to determine if PERSEVERE biomarkers and clinical data could be combined to derive a new model to assess the risk of persistent CPB-related MODS in the early post-operative period. Methods: This study included 306 patients <18 years old admitted to a pediatric cardiac ICU after surgery requiring cardiopulmonary bypass (CPB) for congenital heart disease. Persistent MODS, defined as dysfunction of two or more organ systems on postoperative day 5, was the primary outcome. PERSEVERE biomarkers were collected 4 and 12 hours after CPB. Classification and Regression Tree methodology was used to derive a model to assess the risk of persistent MODS. Results: The optimal model containing interleukin-8 (IL-8), chemokine ligand 3 (CCL3), and age as predictor variables, had an area under the receiver operating characteristic curve (AUROC) of 0.86 (0.81-0.91) for differentiating those with or without persistent MODS, and a negative predictive value of 99% (95-100). Ten-fold cross-validation of the model yielded a corrected AUROC of 0.75. Conclusions: We present a novel risk prediction model to assess the risk for development of multiple organ dysfunction after pediatric cardiac surgery requiring CPB. Pending prospective validation, our model may facilitate identification of a high-risk cohort to direct interventions and studies aimed at improving outcomes via mitigation of post-operative organ dysfunction. Clinical Trial Registration Number: This study does not meet criteria for a clinical trial per the WHO International Clinical Trials Registry Platform as no intervention was performed.
No takes yet. Share an insight, caveat, or question.
Benscoter et al. (2023) conducted a cohort in Congenital heart disease requiring cardiopulmonary bypass (n=306). PERSEVERE-CPB risk model (IL-8, CCL3, and age) was evaluated on Persistent multiple organ dysfunction syndrome (MODS) on postoperative day 5 (AUROC 0.86, 95% CI 0.81-0.91). The PERSEVERE-CPB risk model, incorporating interleukin-8, chemokine ligand 3, and age, predicted persistent multiple organ dysfunction syndrome after pediatric cardiac surgery with an AUROC of 0.86.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: