Lu Chao, Yu Lina, Wei Jinfeng, Chen Jimei, Zhuang Jian, Wang Sheng
Department of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China.
Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China.
Ther Clin Risk Manag. 2019 Jul 9;15:851-860. doi: 10.2147/TCRM.S206147. eCollection 2019.
Despite improvements in neonatal cardiac surgery and postoperative care, hospitalized death for infants with low birth weight remains high.
This study sought to identify predictors of postoperative outcomes in low-birth-weight infants undergoing congenital heart surgery and establish nomograms to predict postoperative intensive-care unit (ICU) stay.
From June 2009 to June 2018, a retrospective review of 114 infants with low birth weight (≤2.5 kg) undergoing congenital heart surgery was conducted at Guangdong Provincial People's Hospital. Purely surgical ligation of patent ductus arteriosus was excluded from this study. A total of 26 clinical variables were chosen for univariate, multivariate, and Cox regression analysis, and 14 variables were analyzed as predictors of postoperative outcomes. Nomograms were established to predict risk of postoperative cardiac ICU (CICU) stay, postoperative neonatal ICU (NICU) stay, and total ICU length of stay in infants with cardiac diseases.
Two variables were independent predictors in multiple logistic regression analysis of hospitalized death: operation weight and Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) risk categories. Six variables were independent predictors in the Cox model of postoperative ICU length of stay, including sex, prematurity, birth weight, preoperative stay time in NICU, diagnostic classification, and STAT risk categories. We calculated concordance-index values to estimate the discriminative ability of models of risk of postoperative CICU stay, postoperative NICU stay, and total ICU length of stay, with values of 0.758 (95% CI 0.696-0.820), 0.604 (95% CI 0.525-0.682), and 0.716 (95% CI 0.657-0.776), which indicated the possibility of true-positive results.
Our findings might help clinicians predict postoperative outcomes and optimize therapeutic strategies.
尽管新生儿心脏手术及术后护理有所改善，但低体重婴儿的住院死亡率仍然很高。
本研究旨在确定接受先天性心脏手术的低体重婴儿术后结局的预测因素，并建立列线图以预测术后重症监护病房（ICU）住院时间。
2009年6月至2018年6月，对广东省人民医院114例接受先天性心脏手术的低体重（≤2.5 kg）婴儿进行回顾性研究。本研究排除单纯手术结扎动脉导管未闭的病例。共选择26个临床变量进行单因素、多因素和Cox回归分析，其中14个变量作为术后结局的预测因素进行分析。建立列线图以预测患有心脏病婴儿术后心脏ICU（CICU）住院风险、术后新生儿ICU（NICU）住院风险及ICU总住院时间。
在住院死亡的多因素逻辑回归分析中，两个变量为独立预测因素：手术体重和胸外科医师协会-欧洲心胸外科协会（STAT）风险分类。在术后ICU住院时间的Cox模型中，六个变量为独立预测因素，包括性别、早产、出生体重、术前在NICU的住院时间、诊断分类和STAT风险分类。我们计算一致性指数值以评估术后CICU住院风险、术后NICU住院风险及ICU总住院时间模型的判别能力，其值分别为0.758（95%CI 0.696 - 0.820）、0.604（95%CI 0.525 - 0.682）和0.716（95%CI 0.657 - 0.776），表明存在真阳性结果的可能性。
我们的研究结果可能有助于临床医生预测术后结局并优化治疗策略。
