Plasma brain injury biomarkers have been associated with acute neurologic injury in ECMO. In this two-center prospective cohort study of children on ECMO, we aimed to evaluate a panel of plasma biomarkers with exploratory factor analysis (EFA) to better understand their interplay and association with outcomes. Peak biomarker levels from 95 participants were processed by EFA, a technique that uses unsupervised learning to uncover unique clusters of biomarkers within individuals. Unfavorable outcome was defined as in-hospital mortality or Pediatric Cerebral Performance Category ≥3 with decline >1 point. EFA grouped 11 brain injury biomarkers into three factors. Factor 1 comprised markers of cellular brain injury (NSE, BDNF, GFAP, S100b, MCP1, VILIP-1, and neurogranin); Factor 2 comprised markers related to vascular processes (vWF, PDGFR-b, and NPTX1); and Factor 3 comprised the BDNF/MMP-9 signaling pathway. Univariable linear regression analyses demonstrated that unfavorable outcomes had higher mean Factor 1 and 2 levels (+0.91, p<0.001 and +0.50, p=0.015) and lower mean Factor 3 levels (-0.49, p=0.017) compared to favorable outcomes. Multivariable logistic models similarly demonstrated that higher Factor 1 and 2 scores were associated with higher odds of unfavorable outcomes (adjusted OR 2.88 [1.61, 5.66] and 1.89 [1.12, 3.43]). Higher Factor 3 scores were associated with lower odds of unfavorable outcomes (adjusted OR 0.54 [0.31, 0.88]), which is biologically plausible given that BDNF has roles in neuroplasticity. Application of EFA on plasma brain injury biomarkers in children on ECMO yielded identification and grouping of biomarkers into three factors that were significantly associated with outcomes.
We conducted a systematic review to assess outcomes in Hispanic donors and explore how Hispanic ethnicity was characterized. We searched PubMed, EMBASE, and Scopus through October 2021. Two reviewers independently screened study titles, abstracts, and full texts; they also qualitatively synthesized results and independently assessed quality of included studies. Eighteen studies met our inclusion criteria. Study sample sizes ranged from 4007 to 143,750 donors and mean age ranged from 37 to 54 years. Maximum follow-up time of studies varied from a perioperative donor nephrectomy period to 30 years post-donation. Hispanic donors ranged between 6% and 21% of the donor populations across studies. Most studies reported Hispanic ethnicity under race or a combined race and ethnicity category. Compared to non-Hispanic White donors, Hispanic donors were not at increased risk for post-donation mortality, end-stage kidney disease, cardiovascular disease, non-pregnancy-related hospitalizations, or overall perioperative surgical complications. Compared to non-Hispanic White donors, most studies showed Hispanic donors were at higher risk for diabetes mellitus following nephrectomy; however, mixed findings were seen regarding the risk for post-donation chronic kidney disease and hypertension. Future studies should evaluate cultural, socioeconomic, and geographic differences within the heterogeneous Hispanic donor population, which may further explain variation in health outcomes.
