Prognostic Value of Biomarkers in Children and Adolescents With Orthostatic Intolerance.

Huijuan Yan,Ping Liu,Runmei Zou,Juan Zhang,Hong Cai,Cheng Wang,Yuwen Wang,Shuo Wang

doi:10.3389/fped.2021.752123

Abstract

Orthostatic intolerance (OI) refers to a series of symptoms that occur during upright standing, which can be relieved when returned to the supine position. OI is a common cause of syncope in children and adolescents. In recent years, more and more studies have been carried out to assess the prognosis of OI by using biomarkers, among which, flow-mediated vasodilation, left ventricular ejection fraction and fractional shortening, hemodynamic change during head-up tilt test, detection of 24-h urinary sodium excretion, body mass index, midregional pro-adrenomedullin, and erythrocytic H2S producing rate are relatively stable, inexpensive, and easy to obtain. With the help of biomarkers, individualized treatment can be carried out to improve the long-term prognosis of children and adolescents with OI. This article reviews the prognostic value of biomarkers in children and adolescents with OI.

Highlights

Orthostatic intolerance (OI) is a series of symptoms during upright standing that can be relieved when returned to the supine position, such as lightheadedness, headache, fatigue, visual difficulties, pallor, palpitations, nausea, and sweating [1]
The results showed that when rate-pressure product (RPP) at Head-up tilt test (HUTT) 5 min (RPP5) was 11,548.5 bpm·mmHg, the area under the curve (AUC) was 0.669, the sensitivity and specificity to predict the response after postural tachycardia syndrome (POTS) intervention were 81.8 and 61.7%, respectively
There has been more research on the prognosis of OI in recent years, especially for vasovagal syncope (VVS) and POTS, and the predictive value of biomarkers has been gradually popularized in clinical practice

Summary

INTRODUCTION

Orthostatic intolerance (OI) is a series of symptoms during upright standing that can be relieved when returned to the supine position, such as lightheadedness, headache, fatigue, visual difficulties, pallor, palpitations, nausea, and sweating [1]. Biomarkers can be used for qualitative or quantitative testing to reflect the changes in disease conditions and assess the efficacy They provide an objective basis for guiding clinical judgment on the prognosis of VVS and POTS in children and adolescents, which is of great clinical value. Increasing HGB, PLT, and MCH might be the risk factors of recurrence in children with VVS Children in both studies were treated with basic treatment (including predisposing causes avoiding, standing training, autonomic nervous function exercise, and oral rehydration salts). Both studies demonstrated the relationship between HGB, PLT, and syncope recurrence, but the contrary results of MCH. With the AUC of 0.758, salivary cortisol >4.1 ng/ml at awakening yielded 83.3% sensitivity and 68.7% specificity in predicting therapeutic efficacy of sleep-promoting treatment in POTS (Table 2). The results showed that 24-h urine sodium excretion of patients with POTS was lower than controls

CONCLUSION

Findings

SUMMARY