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Clinical Chemistry 53: 982-985, 2007. First published March 15, 2007; 10.1373/clinchem.2006.077149
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(Clinical Chemistry. 2007;53:982-985.)
© 2007 American Association for Clinical Chemistry, Inc.

Technical Briefs

Perioperative Activin A Concentrations as a Predictive Marker of Neurologic Abnormalities in Children after Open Heart Surgery

Pasquale Florio1, Raul Felipe Abella2, Teresa de la Torre2, Alessandro Giamberti2, Stefano Luisi1, Gianfranco Butera2, Alessandro Cazzaniga2, Alessandro Frigiola2, Felice Petraglia1 and Diego Gazzolo3,4,a

1 Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy; 2 Department of Cardiac Surgery S. Donato Milanese University Hospital, San Donato Milanese, Italy; 3 Department of Pediatrics and Neuroscience, G. Gaslini Children’s Hospital, Genoa, Italy; 4 Department of Maternal Fetal and Neonatal Health G. Garibaldi Hospital, Catania, Italy

aAddress correspondence to this author at: Department of Maternal Fetal and Neonatal Health, G. Garibaldi Hospital, Via Palermo 636, I-95100 Catania, Italy; fax 39-95-7595208, e-mail dgazzolo{at}hotmail.com


Abstract

Background: Ischemic-reperfusion injury of the brain is a major adverse event after cardiac surgery, especially when extracorporeal circuits are used. Because brain injury induces local overproduction of activin A, we measured plasma concentrations in children after open heart surgery with cardiopulmonary bypass (CPB) to investigate the potential of measuring activin A for early identification of infants at risk for brain damage.

Methods: We evaluated 45 infants (age <1 year) with congenital heart defects: 36 without overt neurologic injury, and 9 with neurologic injury on day 7 after the surgical procedure. Blood samples were taken before surgery, during surgery before CPB, at the end of CPB, at the end of surgery, and at 12 h after surgery. Neurologic development was assessed before surgery and on postoperative day 7.

Results: Activin A concentrations increased significantly during surgery (P <0.0001) to a maximum at the end of CPB. Infants who developed abnormal neurologic sequelae had concentrations significantly higher (P <0.0001, all comparisons) than patients with normal neurologic outcome at all evaluated times, but not before surgery. Activin A had a sensitivity of 100% (95% CI, 66%–100%) and a specificity of 100% (95% CI, 90%–100%) as a single marker for predicting neurologic abnormalities (area under the ROC curve, 1.0).

Conclusions: Activin A increases in children who experience poor neurologic outcomes after open heart surgery, and its assay may help in early identification of infants at risk for brain damage.






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