Clinical scores associated with immunological biomarker in the assessment of severity in congenital heart surgery

Abstract

Abstract Background Congenital heart disease is a common disorder that often results in surgical procedures and intensive care. In this way, the use of validated scales and biomarkers can be incorporated into care practice as a tool for assessment and care planning. Purpose We aimed to investigate the association between the Therapeutic Intervention Scoring System (TISS-28), the risk-adjusted score for surgery in congenital heart disease (RACHS-1) and the triggering receptor expressed on myeloid cells-1 (sTREM-1) in assessing the clinical severity of cardiac surgery in pediatric patients. Methods This is an exploratory, translational cross-sectional study of 32 children undergoing cardiac surgical repair between 2021 and 2022. The severity of heart disease was determined using the RACHS-1 score and clinical severity using the TISS-28, the scores were stratified into C4, C3, C2 and C1, with C4 being the highest severity and C1 being the lowest, according to each assessment instrument, and the associations with sTREM-1 (pre- and post-surgery), measured by the ELISA method. The data were analyzed using the Statistical Package for the Social Sciences - SPSS version 29.0 software, considering statistical significance values of p < 0.05. Results Regarding the mean sTREM-1 values preoperative in comparison to the RACHS-1 categories, there was a significant difference between category C4 (241.33 pg/mL) and C3 (161.5 pg/mL) (p = 0.019), and postoperatively between C4 (355.82 pg/mL) and C1 (222.53 pg/mL), C2 (291.02 pg/mL) and C3 (296.66 pg/mL) (p = 0.005; 0.040; and 0.040, respectively). Preoperative, compared to the TISS-28 and sTREM-1 categories, there was a significant difference between category C4 (241.33 pg/mL) and C3 (161.5 pg/mL) (p = 0.020), and postoperatively, between categories C4 (355.82 pg/mL) and C2 (275.22 pg/mL) (p = 0.040). Conclusions We concluded that, both pre- and postoperatively, the mean sTREM-1 values were higher in the group of patients classified as more severe according to the RACHS-1 and TISS-28, when compared to those in the lower strata, showing that patients with higher sTREM-1 values preoperative evolved to greater severity postoperatively, a fact that was repeated in the post-operative evaluation.Table - RACHS-1 and sTREM-1Table - TISS-28 and sTREM-1