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Elevated Preoperative Serum Asymmetrical Dimethylarginine (ADMA) Is Associated With Poor Outcomes After Pediatric Cardiac Surgery FREE TO VIEW

Amanda Hassinger*, MD; Mark Wainwright, MD; Jerome Lane, MD; Shannon Haymond, PhD; Carl Backer, MD; Eric Wald, MD
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Women and Children's Hospital of Buffalo, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY

Chest. 2012;142(4_MeetingAbstracts):404A. doi:10.1378/chest.1385790
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SESSION TYPE: Post operative ICU issues Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Asymmetrical dimethylarginine (ADMA), an endogenous competitive inhibitor of nitric oxide synthase, is elevated in vascular pathologies such as hypertension and chronic kidney disease. Children undergoing cardiac surgery are at high risk for poor cardiac and renal outcomes secondary to cardiopulmonary bypass (CPB). This study tested the hypothesis that elevated pre-operative ADMA levels are associated with overall worse clinical outcomes after pediatric CPB.

METHODS: Prospective, observational study of 100 patients aged 2 weeks to 18 years who underwent cardiac surgery involving CPB. Serum ADMA levels were obtained pre-operatively and on post-operative day (POD) zero through four. Clinical outcomes measured include acute kidney injury (AKI) by pRIFLE criteria and renal impairment defined as an absolute estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2, low cardiac output syndrome (LCOS), length of mechanical ventilation (LMV), hospital and ICU length of stay (LOS), mortality, and unplanned re-operation.

RESULTS: The 29 (29%) patients with an elevated pre-operative ADMA were more likely to have extended LMV, LOS in the ICU and hospital, renal impairment and LCOS than those with a normal pre-operative ADMA. ADMA levels through POD 2 inversely correlated with eGFR but did not predict or correlate with post-CPB AKI according to pRIFLE criteria. Pre-operative ADMA levels correlated with LOS in the hospital, rs=0.289, in the ICU, rs=0.308, and LMV, rs=0.402, [all p-values<0.05]. ADMA levels before surgery had good predictive power for prolonged mechanical ventilation, >2 days, (ROC-AUC 0.809, 95%CI 0.704,0.914 p<0.001).

CONCLUSIONS: Patients with elevated ADMA before surgery were more likely to develop renal impairment, prolonged mechanical ventilation, LCOS, extended LOS and require re-operation. Post-operative increase in ADMA correlated with a loss of renal function but did not predict AKI.

CLINICAL IMPLICATIONS: Pre-operative serum ADMA may identify pediatric cardiac surgery patients at risk for poor post-operative outcomes following CPB.

DISCLOSURE: The following authors have nothing to disclose: Amanda Hassinger, Mark Wainwright, Jerome Lane, Shannon Haymond, Carl Backer, Eric Wald

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Women and Children's Hospital of Buffalo, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY




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