Correlation of pre-operative plasma protein concentrations in cardiac surgery patients with bleeding outcomes using a targeted quantitative proteomics approach.

PURPOSE: Despite recent advancements in the use of thrombelastography (TEG) in the surgical setting, adequate technology to accurately predict bleeding phenotypes for patients undergoing cardiopulmonary bypass on the basis of non-mechanical parameters is lacking. While basic science and translational studies have provided key mechanistic insights about the protein components of coagulation cascades and regulatory mediators of hemostasis and fibrinolysis, targeted protein assays are still missing and the association of protein profiles to bleeding phenotypes and TEG readouts have yet to be discovered. OBJECTIVE: To identify protein biomarkers of bleeding phenotypes of cardiopulmonary bypass patients in pre-operative plasma. EXPERIMENTAL DESIGN: We applied a targeted proteomics approach to quantify 123 plasma proteins from 23 patients undergoing cardiopulmonary bypass (CPB) and sternotomy. We then correlated these measurements to bleeding outcomes and TEG parameters, associated with speed of clot formation and strength. RESULTS: In this pilot study, we demonstrate the feasibility of protein quantitation as a viable strategy to predict low versus high bleeding phenotypes (loss of < or > than 20% of estimated blood volume, calculated as 70 mL/kg for BMI<29.9, 60 mL/kg for BMI = 30-39.9, and 50 mL/kg for BMI>40. Statistical elaborations highlighted a core set of proteins showing significant correlations to either total blood loss or TEG R/MA parameters. CONCLUSION AND CLINICAL RELEVANCE: Though prospective verification and validation in larger cohorts will be necessary, this report suggests a potential for targeted quantitative proteomics of pre-operative plasma protein concentrations in the prediction of estimated blood loss following CPB.

Pain Control and Parent Mental Health Among Pediatric Inpatients.

OBJECTIVE: Pain control remains a problem for hospitalized children, with more than half experiencing ongoing pain. Pain in turn negatively affects child quality of life. To clarify the relationship between inpatient pain control and parent and child psychological factors, we tested the hypotheses that pain control is worse in the context of higher child executive function problems, lower parent mindfulness, and higher parent mental health symptoms. METHODS: We conducted an observational study of stable pediatric inpatients' (n = 81; mean age = 10.5 [SD 4.7]; 55% male) nurse-recorded pain scores; physical health and executive function; and parental cognitive-affective mindfulness and mental health. Linear mixed models examined associations between these variables and changes in pain scores over time, adjusting for covariates. RESULTS: After adjusting for child age, child gender, and parent educational status, both time (ß = -.23, P = .003) and baseline pain (ß = .43, P < .001) were related to pain control. After adjusting for demographics, time, and baseline pain, both parental anxiety (ß = .11, P < .001) and depression (ß = .12, P < .001) were significantly related to pain control. CONCLUSIONS: Child pain control worsened with higher parent anxiety and depression. The results highlight the importance of offering mental health resources to distressed parents of hospitalized children in pain.