Risk Factors of Mortality in the Intensive Care Unit Following Cardiac Surgery for Congenital Heart Diseases in Children

IF 0.4 4区 医学 Q4 PEDIATRICS Iranian Journal of Pediatrics Pub Date : 2023-07-16 DOI:10.5812/ijp-132744
M. Sharifi, M. Mirzaaghayan, Sara Memarian, Hamid Sharifi, B. Gharib
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Abstract

Background: Children with congenital heart diseases (CHDs) often require cardiac surgery, whose outcome depends on many preoperative, intraoperative, and postoperative factors. Objectives: We aimed to investigate the factors associated with in-hospital mortality among patients undergoing pediatric heart surgery for CHDs. Methods: This retrospective cross-sectional study included patients younger than 18 who underwent cardiac surgery due to CHDs at the Children's Medical Center of Tehran University of Medical Sciences and were admitted to the open-heart surgery intensive care unit (OH-ICU) between March 2018 and March 2019. Patients with incomplete records were excluded. The collected data included age (months), weight (kg), type of congenital defect, duration of intensive care unit (ICU) stay, cardiopulmonary bypass (CPB) time, aortic cross-clamping (XCT) time, postoperative (day 1) platelet count and neutrophil-to-lymphocyte ratio (NLR), and mortality. Results: This study included 275 CHD patients who underwent cardiac surgery. The mean age and weight were 32.54 ± 37.4 months and 11.01 ± 8.43 kg, respectively. Those who died were younger (P = 0.05) and had lower weights (P = 0.001). An inverse relationship existed between thrombocytopenia and mortality. The NLR was higher in those who survived (mean 4.08 vs. 2.87), while the deceased patients had an extended duration of hospitalization, longer CPB time, and longer XCT time. Conclusions: Younger age, lower body weight, lower NLR ratio, lower platelet count, longer intraoperative CPB time, and XCT time were not associated with increased in-hospital mortality following cardiac surgery for CHDs. The Risk Adjustment for Congenital Heart Surgery (RACHS-1) score was not significantly related to mortality. Also, CPB and XCT times were significantly longer in cyanotic than in non-cyanotic patients. Cyanotic patients also had significantly lower platelets than non-cyanotic patients after the operation. Large, multicenter studies are needed to further investigate the predictors of mortality following surgery for CHDs.
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儿童先天性心脏病心脏手术后重症监护病房死亡率的危险因素
背景:先天性心脏病(CHDs)患儿经常需要心脏手术,其预后取决于许多术前、术中和术后因素。目的:我们的目的是调查与接受小儿心脏手术治疗冠心病患者住院死亡率相关的因素。方法:本回顾性横断面研究纳入了2018年3月至2019年3月期间在德黑兰医科大学儿童医学中心因冠心病接受心脏手术并入住心内直视手术重症监护病房(OH-ICU)的18岁以下患者。排除记录不完整的患者。收集的数据包括年龄(月)、体重(kg)、先天性缺陷类型、重症监护病房(ICU)住院时间、体外循环(CPB)时间、主动脉交叉夹闭(XCT)时间、术后(第1天)血小板计数、中性粒细胞与淋巴细胞比值(NLR)和死亡率。结果:本研究纳入了275例接受心脏手术的冠心病患者。平均年龄32.54±37.4个月,平均体重11.01±8.43 kg。死亡的患者更年轻(P = 0.05),体重更低(P = 0.001)。血小板减少症与死亡率呈负相关。存活患者NLR较高(平均4.08 vs 2.87),而死亡患者住院时间延长,CPB时间延长,XCT时间延长。结论:年龄较小、体重较轻、NLR比较低、血小板计数较低、术中CPB时间较长和XCT时间与冠心病心脏手术后住院死亡率增加无关。先天性心脏手术风险调整(RACHS-1)评分与死亡率无显著相关。同时,紫绀患者的CPB和XCT时间明显长于非紫绀患者。紫绀患者术后血小板也明显低于非紫绀患者。需要大规模的多中心研究来进一步研究冠心病手术后死亡率的预测因素。
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来源期刊
CiteScore
0.90
自引率
20.00%
发文量
75
审稿时长
6-12 weeks
期刊介绍: Iranian Journal of Pediatrics (Iran J Pediatr) is a peer-reviewed medical publication. The purpose of Iran J Pediatr is to increase knowledge, stimulate research in all fields of Pediatrics, and promote better management of pediatric patients. To achieve the goals, the journal publishes basic, biomedical, and clinical investigations on prevalent diseases relevant to pediatrics. The acceptance criteria for all papers are the quality and originality of the research and their significance to our readership. Except where otherwise stated, manuscripts are peer-reviewed by minimum three anonymous reviewers. The Editorial Board reserves the right to refuse any material for publication and advises that authors should retain copies of submitted manuscripts and correspondence as the material cannot be returned. Final acceptance or rejection rests with the Editors.
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