Key result
Augmenting a clinical model with pre- and post-operative biomarkers significantly improved the prediction of 30-day unplanned readmission or mortality (AUC 0.802 vs 0.617; P=0.003).
Why the study?
The study was designed to evaluate whether novel pre- and post-operative biomarkers associate with 30-day unplanned readmission or mortality following paediatric congenital heart surgery.
Does the addition of novel biomarkers to a clinical model improve the prediction of 30-day unplanned readmission or mortality in children undergoing congenital heart surgery?
Cohort (n=162)
No
Does the addition of novel biomarkers to a clinical model improve the prediction of 30-day unplanned readmission or mortality in children undergoing congenital heart surgery?
Effect estimate: AUC 0.802 (95% CI 0.72-0.89)
p-value: p=0.003
The addition of novel pre- and post-operative biomarkers to standard clinical models significantly improves the prediction of 30-day unplanned readmission or mortality after pediatric congenital heart surgery.
Novel biomarkers may stratify readmission or mortality risk after pediatric congenital heart surgery; hypothesis-generating and requires prospective validation.
OBJECTIVE: To evaluate the association between novel pre- and post-operative biomarker levels and 30-day unplanned readmission or mortality after paediatric congenital heart surgery. METHODS: Children aged 18 years or younger undergoing congenital heart surgery (n = 162) at Johns Hopkins Hospital from 2010 to 2014 were enrolled in the prospective cohort. Collected novel pre- and post-operative biomarkers include soluble suppression of tumorgenicity 2, galectin-3, N-terminal prohormone of brain natriuretic peptide, and glial fibrillary acidic protein. A model based on clinical variables from the Society of Thoracic Surgery database was developed and evaluated against two augmented models. RESULTS: Unplanned readmission or mortality within 30 days of cardiac surgery occurred among 21 (13%) children. The clinical model augmented with pre-operative biomarkers demonstrated a statistically significant improvement over the clinical model alone with a receiver-operating characteristics curve of 0.754 (95% confidence interval: 0.65-0.86) compared to 0.617 (95% confidence interval: 0.47-0.76; p-value: 0.012). The clinical model augmented with pre- and post-operative biomarkers demonstrated a significant improvement over the clinical model alone, with a receiver-operating characteristics curve of 0.802 (95% confidence interval: 0.72-0.89; p-value: 0.003). CONCLUSIONS: Novel biomarkers add significant predictive value when assessing the likelihood of unplanned readmission or mortality after paediatric congenital heart surgery. Further exploration of the utility of these novel biomarkers during the pre- or post-operative period to identify early risk of mortality or readmission will aid in determining the clinical utility and application of these biomarkers into routine risk assessment.
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Brown et al. (2019) conducted a cohort in paediatric congenital heart surgery (n=162). Pre- and post-operative biomarkers vs. Clinical model alone was evaluated on 30-day unplanned readmission or mortality (AUC 0.802, 95% CI 0.72-0.89, p=0.003). Augmenting a clinical model with pre- and post-operative biomarkers significantly improved the prediction of 30-day unplanned readmission or mortality (AUC 0.802 vs 0.617; P=0.003).
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