Abstract 4139628: Postoperative Risk Stratification For Complex Congenital Heart Disease Based On Age-adjusted NT-proBNP

Background: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is extensively utilized in the prognosis of cardiovascular disease for adults, but its clinical significance for pediatric cardiology is poorly understood. Objectives: This study aimed to explore the prognostic value of age-adjusted NT-proBNP (zlog-proBNP) in pediatric patients with CCHD. Methods: This retrospective study included 2681 patients with CCHD (median age at surgery, 10.6 months; male, 59%), and the median follow-up time was 3.0 years (range, 1 day–6.2 years). The primary endpoint was death, and the composite events were death and unplanned cardiac reintervention. NT-proBNP level was measured within 24 h after surgery and transformed into zlog-proBNP. Results: NT-proBNP level increased to a median absolute value of 3970 (interquartile range [IQR], 1352–9095), and a median zlog-proBNP value of 3.83 (IQR, 2.93–4.44) on postoperative day 1, reaching its peak at approximately 12h. Compared with patients with low zlog-proBNP value (≤1.96), those with very high zlog-proBNP value (>5; hazard ratio [HR] for death, 9.78 [3.17-30.22, p <0.001]; HR for composite events, 3.64 [1.95-6.79, p <0.001]) had higher risk of death and composite events, followed by patients with high (>3.8 to ≤5; HR for death, 5.27 [1.79-15.53, p =0.003]; HR for composite events, 2.28 [1.29-4.03, p =0.004]) and moderate (>1.96 to ≤3.8; HR for death, 3.83 [1.31-11.17, p =0.014]; HR for composite events, 1.53 [0.87-2.69, p =0.139]) zlog-proBNP values. Conclusions: Zlog-proBNP demonstrates substantial prognostic significance in patients with CCHD, warranting particular clinical attention in those with a zlog-proBNP value >5.