Plasma and Urinary FGF-2 and VEGF-A Levels Identify Children at Risk for Severe Bleeding after Pediatric Cardiopulmonary Bypass: A Pilot Study.

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Published Jun 18, 2020
DOI: https://doi.org/10.18103/mra.v8i6.2134

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Anthony A. Sochet, MD, MSc
Division of Critical Care Medicine, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010
Elizabeth A. Wilson, MD, MSHS
Division of Critical Care Medicine, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010
Jharna R. Das, PhD
Division of Nephrology, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010
John T. Berger, MD
Division of Critical Care Medicine and Cardiology, Department of Pediatrics, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010
Patricio E Ray, MD
Nephrology

Abstract

Severe bleeding after cardiothoracic surgery with cardiopulmonary bypass (CPB) is associated with increased morbidity and mortality in adults and children. Fibroblast Growth Factor-2 (FGF-2) and Vascular Endothelial Growth Factor-A (VEGF-A) induce hemorrhage in murine models with heparin exposure. We aim to determine if plasma and urine levels of FGF-2 and VEGF-A in the immediate perioperative period can identify children with severe bleeding after CPB. We performed a prospective, observational biomarker study in 64 children undergoing CPB for congenital heart disease repair from June 2015 - January 2017 in a tertiary pediatric referral center. Primary outcome was severe bleeding defined as ≥ 20% estimated blood volume loss within 24-hours. Independent variables included perioperative plasma and urinary FGF-2 and VEGF-A levels. Analyses included comparative (Wilcoxon rank sum, Fisher’s exact, and Student’s t tests) and discriminative (receiver operator characteristic [ROC] curve) analyses.


Forty-eight (75%) children developed severe bleeding. Median plasma and urinary FGF-2 and VEGF-A levels were elevated in children with severe bleeding compared to without bleeding (preoperative: plasma FGF-2 = 16[10-35] vs. 9[2-13] pg/ml; urine FGF-2= 28[15-76] vs. 14.5[1.5-22] pg/mg; postoperative: plasma VEGF-A = 146[34-379] vs. 53[0-134] pg/ml; urine VEGF-A = 132[52-257] vs. 45[0.1-144] pg/mg; all p < 0.05). ROC curve analyses of combined plasma and urinary FGF-2 and VEGF-A levels discriminated severe postoperative bleeding (AUC: 0.73-0.77) with mean sensitivity and specificity above 80%.  We conclude that the perioperative plasma and urinary levels of FGF-2 and VEGF-A discriminate risk of severe bleeding after pediatric CPB.

Keywords: Cardiopulmonary bypass surgery, heparin, Fibroblast Growth Factor 2, bleeding

Article Details

How to Cite
SOCHET, Anthony A. et al. Plasma and Urinary FGF-2 and VEGF-A Levels Identify Children at Risk for Severe Bleeding after Pediatric Cardiopulmonary Bypass: A Pilot Study.. Medical Research Archives, [S.l.], v. 8, n. 6, june 2020. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2134>. Date accessed: 16 apr. 2024. doi: https://doi.org/10.18103/mra.v8i6.2134.
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Issue
Vol 8 No 6 (2020): Vol.8 Issue 6 June, 2020
Section
Research Articles

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