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Observational Study
. 2025 May 1;26(5):e622-e632.
doi: 10.1097/PCC.0000000000003717. Epub 2025 Mar 10.

Syndecan-1 as a Biomarker for Fluid Overload After High-Risk Pediatric Cardiac Surgery: A Pilot Study

Matthew A Solomon  1   2 , David S Hains  2   3 , Andrew L Schwaderer  2   3 , Katie Gallaway  1 , Colin J Sallee  4 , Francis Pike  5 , Sam Arregui  3 , Daniel T Cater  1   2 , Christopher W Mastropietro  1   2 , Courtney M Rowan  1   2
Affiliations
Observational Study

Syndecan-1 as a Biomarker for Fluid Overload After High-Risk Pediatric Cardiac Surgery: A Pilot Study

Matthew A Solomon et al. Pediatr Crit Care Med. .

Abstract

Objective: Fluid overload (FO) after pediatric cardiac surgery with cardiopulmonary bypass (CPB) is common and has been associated with poor outcomes. We aimed to describe the relationship between plasma concentrations of syndecan-1 (SD1), a biomarker of endothelial glycocalyx injury, and FO in a cohort of children undergoing cardiac surgery.

Design: Single-center prospective observational pilot study, 2022-2023.

Setting: Twenty-six-bed pediatric cardiac ICU (CICU) at a quaternary pediatric referral center.

Patients: Children younger than 18 years old undergoing Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery congenital heart surgery mortality category 3, 4, and 5 cardiac surgeries with CPB.

Interventions: None.

Measurements and main results: We enrolled 15 patients. Blood samples were collected preoperatively and 4 hours postoperatively, then processed for plasma. SD1 concentrations were measured using enzyme-linked immunosorbent assays and compared with fluid balance on postoperative days (PODs) 1, 2, 3, and peak. SD1 discriminated fluid balance of greater than or equal to 10% on POD-1, POD-2, and POD-3 with an area under the receiver operating characteristic curve (AUROC) of 0.74, 0.84, and 0.88, respectively. SD1 also discriminated peak fluid balance of greater than or equal to 10% occurring on any day over the first seven PODs with an AUROC of 0.94. Patients with greater than or equal to 10% fluid balance on POD-2 ( p = 0.037), POD-3 ( p = 0.020), or peak ( p = 0.021) had significantly elevated delta SD1 when compared with those reaching less than 10%. Fluid balance of greater than or equal to 10% on POD-2 was associated with adverse events including longer duration of mechanical ventilation and CICU stay.

Conclusions: Plasma SD1 was associated with FO in pediatric patients undergoing high-risk cardiac surgery with CPB. Further studies exploring the clinical utility of SD1 as a biomarker for FO in the postoperative management of children who undergo cardiac surgery with CPB should be pursued.

Keywords: cardiac surgical procedures; cardiopulmonary bypass; congenital; glycocalyx; heart defects; syndecan-1.

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Conflict of interest statement

Dr. Solomon’s institution received funding from the Indiana University National Institutes of Health (NIH) T32 Kidney Training Program (DK120524), the National Heart, Lung, and Blood Institute (NHLBI) (K23HL150244), and K12HD111057-01. Drs. Solomon, Cater, and Rowan received support for article research from the NIH. Sam Arregui disclosed work for hire. Dr. Cater’s institution received funding from the National Institute of Child Health and Human Development (K12HD111057-01). Dr. Mastropietro received funding from Bioporto, Spectrum Health, Asklepion Pharmaceuticals, Telan, Meltz, Wallace, Eide Law Firm, Heyl, Royster, Voelker, Allen Law Firm, and Springer Nature Switzerland AG. Dr. Rowan’s institution received funding from the NHLBI. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

    1. Bellos I, Iliopoulos DC, Perrea DN: Association of postoperative fluid overload with adverse outcomes after congenital heart surgery: a systematic review and dose-response meta-analysis. Pediatr Nephrol 2020; 35:1109–1119 - PubMed
    1. Bailly DK, Alten JA, Gist KM, et al.: Fluid Accumulation After Neonatal Congenital Cardiac Operation: Clinical Implications and Outcomes. Ann Thorac Surg 2022; 114:2288–2294 - PMC - PubMed
    1. Goldstein SL, Akcan-Arikan A, Alobaidi R, et al.: Consensus-Based Recommendations on Priority Activities to Address Acute Kidney Injury in Children: A Modified Delphi Consensus Statement. JAMA Netw Open 2022; 5:e2229442. - PMC - PubMed
    1. Neumayr TM, Alge JL, Afonso NS, et al.: Acute Kidney Injury After Pediatric Cardiac Surgery. Pediatr Crit Care Med 2022; 23:e249–e256 - PubMed
    1. Sampaio TZ, O’Hearn K, Reddy D, et al.: The Influence of Fluid Overload on the Length of Mechanical Ventilation in Pediatric Congenital Heart Surgery. Pediatr Cardiol 2015; 36:1692–1699 - PubMed

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