Schiller Ofer, Goldshmid Oran, Mowassi Sahar, Shostak Eran, Manor Orit, Amir Gabriel, Frenkel Georgy, Dagan Ovadia
Pediatric Cardiac Intensive Care Unit, Schneider Children's Medical Center of Israel, 14 Kaplan Street, 4920235, Petach Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel.
Pediatr Cardiol. 2020 Jun;41(5):939-946. doi: 10.1007/s00246-020-02339-6. Epub 2020 Mar 14.
We sought to examine the role of preoperative and 2nd postoperative day albumin levels as predictors for postoperative course in infants undergoing repair of congenital heart disease. This retrospective, single-center, observational study comprised consecutive infants younger than 1 year who had undergone repair of tetralogy of Fallot, ventricular septal defect, complete atrioventricular canal or transposition of the great arteries over a 25 months period. We correlated preoperative and postoperative day (POD) #2 albumin level to vaso-inotropic score (VIS) and intensive care unit (ICU) length of stay (LOS) as markers for degree and duration of postoperative cardiac support. A composite outcome was defined as maximal vaso-inotropic score of > 10 and ICU LOS > 96 h. Preoperative albumin level negatively correlated with VIS and ICU LOS. Compared to preoperative albumin level of > 4 g/dL, the relative risk of meeting composite criteria was 1.5 for preoperative albumin of 3.1-4 g/dL and 2.6 for preoperative albumin ≤ 3 g/dL. Compared to POD#2 albumin level > 3 g/dL, the relative risk of meeting composite criteria was 1.8 for albumin of 2.6-3 g/dL, and 2.5 for albumin ≤ 2.5 g/dL. In summary, we found that preoperative and POD#2 albumin levels predicted prolonged and complicated postoperative course. These finding may help clinicians to inform the patient's parents, early in the ICU hospitalization, as to the predicted risks and difficulties of their infant's postoperative course.
我们试图研究术前及术后第2天白蛋白水平在先天性心脏病修复术患儿术后病程预测中的作用。这项回顾性、单中心观察性研究纳入了连续25个月内接受法洛四联症、室间隔缺损、完全性房室通道或大动脉转位修复术的1岁以下婴儿。我们将术前及术后第2天（POD）的白蛋白水平与血管活性药物评分（VIS）和重症监护病房（ICU）住院时长（LOS）相关联，以此作为术后心脏支持程度和时长的指标。复合结局定义为最大血管活性药物评分>10且ICU住院时长>96小时。术前白蛋白水平与VIS和ICU住院时长呈负相关。与术前白蛋白水平>4 g/dL相比，术前白蛋白水平为3.1 - 4 g/dL时达到复合标准的相对风险为1.5，术前白蛋白水平≤3 g/dL时为2.6。与术后第2天白蛋白水平>3 g/dL相比，白蛋白水平为2.6 - 3 g/dL时达到复合标准的相对风险为1.8，白蛋白水平≤2.5 g/dL时为2.5。总之，我们发现术前及术后第2天白蛋白水平可预测术后病程延长及复杂程度。这些发现可能有助于临床医生在患儿入住ICU早期就向其父母告知患儿术后病程的预测风险和困难。
