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Background <p>Elevated levels of Endothelin-1 (ET-1), a vasoactive peptide, have been associated with adverse outcomes in neonates with congenital diaphragmatic hernia (CDH). However, the relationship between ET-1 levels and clinical outcomes remains poorly understood. This study aimed to investigate the kinetics of ET-1 levels in CDH neonates from birth to 48&#xa0;h postnatally and assess its association with clinical comorbidities, the need for extracorporeal membrane oxygenation (ECMO), and mortality.</p> Methods <p>A prospective single-center study was conducted, including 107 newborns with CDH from 2014 to 2022. Blood samples for ET-1 measurement were collected at birth, 6&#xa0;h, and 48&#xa0;h postnatally. The need for ECMO and mortality served as primary and secondary clinical endpoints. Based on the ET-1 values patients were assigned to ET-1 high, intermediate, and low groups. Statistical analyses, including ROC curve analysis and multivariate logistic regression, were performed to determine the predictive value of ET-1 levels.</p> Results <p>Among the 107 CDH neonates 41 (38.3%) required ECMO and the overall mortality rate was 19.6%. Higher ET-1 levels at 0 and 48&#xa0;h correlated significantly with the need for ECMO (<i>p</i> = 0.028 and <i>p</i> &lt; 0.001) and mortality (<i>p</i> = 0.016 and <i>p</i> &lt; 0.001). The high ET-1 group had a significantly higher rate of ECMO use (63.2%) and higher mortality (42.1%) compared to the ET-1 low group (15.4% and 0%). Furthermore, elevated ET-1 levels were associated with more severe disease characteristics including severe PH and biventricular dysfunction.</p> Conclusions <p>Elevated ET-1 levels during the first 48&#xa0;h of life in CDH neonates are significantly associated with increased rates of ECMO and mortality. These findings underline the potential of ET-1 as a predictive biomarker for poor outcomes in CDH and highlight its relevance in guiding therapeutic interventions.</p> Trial registration <p>DKRS00034329.</p>

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Increased circulating Endothelin-1 is a risk factor for ECMO use and mortality in neonates with congenital diaphragmatic hernia: a prospective observational study

  • 期刊论文

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  • 发表日期：

    2025年3月21日

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  • Lotte Lemloh,
  • Aster de Vadder,
  • Tamene Melaku,
  • Bartolomeo Bo,
  • Neil Patel,
  • Stefan Holdenrieder,
  • Andreas Mueller,
  • Florian Kipfmueller

摘要

Background

Elevated levels of Endothelin-1 (ET-1), a vasoactive peptide, have been associated with adverse outcomes in neonates with congenital diaphragmatic hernia (CDH). However, the relationship between ET-1 levels and clinical outcomes remains poorly understood. This study aimed to investigate the kinetics of ET-1 levels in CDH neonates from birth to 48 h postnatally and assess its association with clinical comorbidities, the need for extracorporeal membrane oxygenation (ECMO), and mortality.

Methods

A prospective single-center study was conducted, including 107 newborns with CDH from 2014 to 2022. Blood samples for ET-1 measurement were collected at birth, 6 h, and 48 h postnatally. The need for ECMO and mortality served as primary and secondary clinical endpoints. Based on the ET-1 values patients were assigned to ET-1 high, intermediate, and low groups. Statistical analyses, including ROC curve analysis and multivariate logistic regression, were performed to determine the predictive value of ET-1 levels.

Results

Among the 107 CDH neonates 41 (38.3%) required ECMO and the overall mortality rate was 19.6%. Higher ET-1 levels at 0 and 48 h correlated significantly with the need for ECMO (p = 0.028 and p < 0.001) and mortality (p = 0.016 and p < 0.001). The high ET-1 group had a significantly higher rate of ECMO use (63.2%) and higher mortality (42.1%) compared to the ET-1 low group (15.4% and 0%). Furthermore, elevated ET-1 levels were associated with more severe disease characteristics including severe PH and biventricular dysfunction.

Conclusions

Elevated ET-1 levels during the first 48 h of life in CDH neonates are significantly associated with increased rates of ECMO and mortality. These findings underline the potential of ET-1 as a predictive biomarker for poor outcomes in CDH and highlight its relevance in guiding therapeutic interventions.

Trial registration

DKRS00034329.