Glial fibrillary acidic protein as a serum neuromarker of brain injury in pediatric patients with congenital heart defects undergoing cardiac surgery

Lacramioara Eliza Chiperi; Adina Hutanu

doi:10.2478/amma-2023-0037

Lacramioara Eliza Chiperi Pediatric Cardiology Department, Emergency institute for heart diseases and transplantation, Targu Mures, Doctoral School, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, Romania
Adina Hutanu Department of Laboratory Medicine, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, Romania, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, Center for Advanced Medical and Pharmaceutical Research, Laboratory of Humoral Immunology,

DOI: https://doi.org/10.2478/amma-2023-0037

Keywords: congenital heart defect, glial fibrillary acidic protein, neurodevelopment

Abstract

Objective: The aim of this study was to assess glial fibrillary acidic protein (GFAP) as a marker of short-term neurodevelopmental delay in pediatric patients with congenital defects (CHD) after cardiovascular surgical intervention.

Methods: Included patients were screened by Denver Developmental Screening Test II scale a few days before and then at 4 to 6 months after the surgical intervention. Blood samples were collected preoperatory and at 24 hours after surgery; GFAP levels were assessed by enzyme-linked immunosorbent assay using commercial kit form BioVendor.

Results: Forty children were enrolled and dichotomized into two groups based on peripheric oxygen saturation: cyanotic (<95%) and non-cyanotic (>=95%) group. 63% form our population had an abnormal neurodevelopmental outcome. Significant differences between groups were found in language domain scores preoperatory (p=0.03) and in fine motor domain postoperatory (p=0.03). In the postoperatory period, GFAP had significantly higher values (p=0.0248) in the cyanotic CHD group. Association between GFAP and NIRS were analyzed and significant differences were found in both groups with a good predicting model in the non-cyanotic CHD group (aria under curve of 0.7 for receiver operative characteristic). Higher GFAP levels from the postoperatory period correlated with neurodevelopmental impairment (mean value of: 0.66 ± 0.02ng/ml in those with good neurodevelopmental score, 0.69 ± 0.02ng/ml in those with low neurodevelopmental score, p=0.01).

Conclusions: GFAP could be a reliable neuromarker in identifying early acute brain injury documented by NIRS monitorization during perioperatory period and it also could identify short term neurodevelopmental impairment documented by lower neurodevelopmental scores.