Pediatric congenital heart disease: inflammatory biomarkers mediate the association between preoperative ZlogNT-proBNP and postoperative prolonged ventilation.

Abstract

Children with congenital heart disease (CHD) often exhibit elevated preoperative NT-proBNP, linked to prolonged postoperative mechanical ventilation. Age-adjusted ZlogNT-proBNP outperforms raw NT-proBNP in predicting outcomes, but its relationship with ventilation duration and underlying inflammatory pathways remain unclear. This retrospective cohort study included 113 CHD children. Preoperative ZlogNT-proBNP were quantified and perioperative cytokines (IL-6, IL-8, IL-10) were measured, as well as postoperative ventilation duration were recorded. Multivariable regression and mediation analyses assessed direct and indirect cytokine-mediated effects on prolonged ventilation. Among the 113 children, 28 (25%) experienced prolonged mechanical ventilation and had significantly higher preoperative ZlogNT-proBNP compared to those with shorter mechanical ventilation durations. Postoperatively, IL-6, IL-8, and IL-10 levels were significantly elevated in the prolonged mechanical ventilation group. Mediation analysis revealed that IL-6, IL-8, and IL-10 partially mediated the association between ZlogNT-proBNP and prolonged mechanical ventilation, with mediation proportions of 28%, 38%, and 37%, respectively. Elevated preoperative ZlogNT-proBNP was significantly associated with prolonged mechanical ventilation, partly via cytokine-mediated inflammatory pathways. These findings suggest that targeting inflammatory pathways may help optimize perioperative care and reduce ventilation duration. 1. Preoperative ZlogNT-proBNP levels and postoperative inflammatory markers (IL-6, IL-8, and IL-10) are significantly associated with prolonged postoperative mechanical ventilation duration. 2. Postoperative inflammatory cytokines (IL-6, IL-8, and IL-10) partially mediate the association between preoperative ZlogNT-proBNP levels and prolonged MV duration.