Independent prognostic value of lipocalin-2 in congenital heart disease-associated pulmonary artery hypertension

Zhang-Ke Guo; Ping-Gui Chen; Yao-Xuan Li; Hong Jiao; Xiao-Hui Kong; Song Bai; Xiao-Feng Li; Ai-Jun Liu; Guo-Liang Wang

doi:10.4330/wjc.v16.i12.720

Independent prognostic value of lipocalin-2 in congenital heart disease-associated pulmonary artery hypertension

World J Cardiol. 2024 Dec 26;16(12):720-730. doi: 10.4330/wjc.v16.i12.720.

Authors

Zhang-Ke Guo¹, Ping-Gui Chen², Yao-Xuan Li³, Hong Jiao⁴, Xiao-Hui Kong⁴, Song Bai¹, Xiao-Feng Li¹, Ai-Jun Liu⁵, Guo-Liang Wang⁶

Affiliations

¹ Department of Cardiac Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
² Department of General Surgery, The Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, Shanxi Province, China.
³ Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China.
⁴ Department of Tumor and Immunology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
⁵ Department of Pediatric Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China.
⁶ Department of Tumor and Immunology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China. wgl163@126.com.

Abstract

Background: Timely and accurate evaluation of the patient's pulmonary arterial pressure (PAP) is of great significance for the treatment of congenital heart disease. Currently, there is no non-invasive gold standard method for evaluating PAP.

Aim: To assess the prognostic value of lipocalin-2 (LCN2) in relation to PAP in patients with congenital heart disease associated with pulmonary artery hypertension.

Methods: We conducted a retrospective analysis of 69 pediatric patients diagnosed with ventricular septal defects. The patients' clinical and laboratory data were collected. The serum LCN2 concentrations were compared between the pulmonary arterial hypertension (PAH) group and the nonPAH group. The correlation of LCN2 concentration with PAH classification was evaluated using binary logistic regression analysis. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic potential of LCN2 for PAH.

Results: Serum LCN2 concentration significantly correlated with patients' mean PAP (r = 0.544, P < 0.001), but not correlated with creatinine (P = 0.446) or blood urea nitrogen (P = 0.747). LCN2 levels were significantly correlated with PAH in both univariate [odds ratio (OR) 1.107, 95%CI: 1.033-1.185, P = 0.004)] and multivariate regression analysis (OR 1.150, 95%CI: 1.027-1.288, P = 0.015). ROC curve analysis revealed an area under the curve of 0.783 for LCN2. At the cutoff value of 19.42 ng/mL, the sensitivity and specificity of LCN2 for diagnosing PAH is 90.19% and 55.56%, respectively. LCN2 concentration also significantly correlated with the post-repair mean PAP in patients with congenital heart disease (r = 0.532, P = 0.009).

Conclusion: LCN2 is emerging as a candidate biomarker for assessing PAP in patients with congenital heart disease. Its high sensitivity in diagnosing PAH makes it a valuable tool in patient management.

Keywords: Biomarker; Congenital heart disease; Endothelin-1; Lipocalin-2; Pulmonary arterial hypertension.