Document Detail


Glial fibrillary acidic protein as a brain injury biomarker in children undergoing extracorporeal membrane oxygenation.
MedLine Citation:
PMID:  21057367     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine whether, in children, plasma glial fibrillary acidic protein is associated with brain injury during extracorporeal membrane oxygenation and with mortality.
DESIGN: Prospective, observational study.
SETTING: Pediatric intensive care unit in an urban tertiary care academic center.
PATIENTS: Neonatal and pediatric patients on extracorporeal membrane oxygenation (n = 22).
INTERVENTIONS: Serial blood sampling for glial fibrillary acidic protein measurements.
MEASUREMENTS AND MAIN RESULTS: Prospective patients age 1 day to 18 yrs who required extracorporeal membrane oxygenation from April 2008 to August 2009 were studied. Glial fibrillary acidic protein was measured using an electrochemiluminescent immunoassay developed at Johns Hopkins. Control samples were collected from 99 healthy children (0.5-16 yrs) and 59 neonatal intensive care unit infants without neurologic injury. In controls, the median glial fibrillary acidic protein concentration was 0.055 ng/mL (interquartile range, 0-0.092 ng/mL) and the 95th percentile of glial fibrillary acidic protein was 0.436 ng/mL. In patients on extracorporeal membrane oxygenation, plasma glial fibrillary acidic protein was measured at 6, 12, and every 24 hrs after cannulation. We enrolled 22 children who underwent extracorporeal membrane oxygenation. Median age was 7 days (interquartile range, 2 days to 9 yrs), and primary extracorporeal membrane oxygenation indication was: cardiac failure, six of 22 (27.3%); respiratory failure, 12 of 22 (54.5%); extracorporeal cardiopulmonary resuscitation, three of 22 (13.6%); and sepsis, one of 22 (4.6%). Seven of 22 (32%) patients developed acute neurologic injury (intracranial hemorrhage, brain death, or cerebral edema diagnosed by imaging). Fifteen of 22 (68%) survived to hospital discharge. In the extracorporeal membrane oxygenation group, peak glial fibrillary acidic protein levels were higher in children with brain injury than those without (median, 5.9 vs. 0.09 ng/mL, p = .04) and in nonsurvivors compared with survivors to discharge (median, 5.9 vs. 0.09 ng/mL, p = .04). The odds ratio for brain injury for glial fibrillary acidic protein >0.436 ng/mL vs. normal was 11.5 (95% confidence interval, 1.3-98.3) and the odds ratio for mortality was 13.6 (95% confidence interval, 1.7-108.5).
CONCLUSIONS: High glial fibrillary acidic protein during extracorporeal membrane oxygenation is significantly associated with acute brain injury and death. Brain injury biomarkers may aid in outcome prediction and neurologic monitoring of patients on extracorporeal membrane oxygenation to improve outcomes and benchmark new therapies.
Authors:
Melania M Bembea; William Savage; John J Strouse; Jamie McElrath Schwartz; Ernest Graham; Carol B Thompson; Allen Everett
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies     Volume:  12     ISSN:  1529-7535     ISO Abbreviation:  Pediatr Crit Care Med     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-08     Completed Date:  2012-05-14     Revised Date:  2014-09-08    
Medline Journal Info:
Nlm Unique ID:  100954653     Medline TA:  Pediatr Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  572-9     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Biological Markers
Brain Injuries / diagnosis*
Child
Child, Preschool
Extracorporeal Membrane Oxygenation / adverse effects*
Female
Glial Fibrillary Acidic Protein / blood*
Humans
Infant
Infant, Newborn
Male
Prospective Studies
Grant Support
ID/Acronym/Agency:
1KL2RR025006-01/RR/NCRR NIH HHS; 1U54HL090515/HL/NHLBI NIH HHS; 5K12HL087169/HL/NHLBI NIH HHS; 5R01HL091759/HL/NHLBI NIH HHS; 5T15HL086386/HL/NHLBI NIH HHS; K23 HL078819/HL/NHLBI NIH HHS; KL2 RR025006/RR/NCRR NIH HHS; L40 HL090401/HL/NHLBI NIH HHS; UL1 RR 025005/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Glial Fibrillary Acidic Protein
Comments/Corrections
Comment In:
Pediatr Crit Care Med. 2011 Sep;12(5):603-4   [PMID:  21897166 ]

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