Loomba Rohit S, Rausa Jacqueline, Dorsey Vincent, Bronicki Ronald A, Villarreal Enrique G, Flores Saul
Division of Cardiology, Advocate Children's Hospital, Chicago, IL, USA.
Department of Pediatrics, Chicago Medical School/Rosalind Franklin University of Medicine and Science, Chicago, IL, USA.
Cardiol Young. 2021 Mar;31(3):406-413. doi: 10.1017/S1047951120004175. Epub 2020 Dec 16.
Children with congenital heart disease and cardiomyopathy are a unique patient population. Different therapies continue to be introduced with large practice variability and questionable outcomes. The purpose of this study is to determine the impact of various medications on intensive care unit length of stay, total length of stay, billed charges, and mortality for admissions with congenital heart disease and cardiomyopathy.
We identified admissions of paediatric patients with cardiomyopathy using the Pediatric Health Information System database. The admissions were then separated into two groups: those with and without inpatient mortality. Univariate analyses were conducted between the groups and the significant variables were entered as independent variables into the regression analyses.
A total of 10,376 admissions were included these analyses. Of these, 904 (8.7%) experienced mortality. Comparing patients who experienced mortality with those who did not, there was increased rate of acute kidney injury with an odds ratio (OR) of 5.0 [95% confidence interval (CI) 4.3 to 5.8, p < 0.01], cardiac arrest with an OR 7.5 (95% CI 6.3 to 9.0, p < 0.01), and heart transplant with an OR 0.3 (95% CI 0.2 to 0.4, p < 0.01). The medical interventions with benefit for all endpoints after multivariate regression analyses in this cohort are methylprednisolone, captopril, enalapril, furosemide, and amlodipine.
Diuretics, steroids, angiotensin-converting enzyme inhibitors, calcium channel blockers, and beta blockers all appear to offer beneficial effects in paediatric cardiomyopathy admission outcomes. Specific agents within each group have varying effects.
患有先天性心脏病和心肌病的儿童是一个独特的患者群体。不同的治疗方法不断被引入，但实践差异很大且疗效存疑。本研究的目的是确定各种药物对先天性心脏病和心肌病入院患者在重症监护病房的住院时间、总住院时间、计费费用和死亡率的影响。
我们使用儿科健康信息系统数据库确定了患有心肌病的儿科患者的入院情况。然后将这些入院患者分为两组：有住院死亡和无住院死亡的患者。对两组进行单因素分析，并将显著变量作为自变量纳入回归分析。
这些分析共纳入10376例入院患者。其中，904例（8.7%）死亡。将死亡患者与未死亡患者进行比较，急性肾损伤发生率增加，比值比（OR）为5.0[95%置信区间（CI）4.3至5.8，p<0.01]，心脏骤停的OR为7.5（95%CI 6.3至9.0，p<0.01），心脏移植的OR为0.3（95%CI 0.2至0.4，p<0.01）。在该队列中，多因素回归分析后对所有终点均有益的医学干预措施是甲泼尼龙、卡托普利、依那普利、呋塞米和氨氯地平。
利尿剂、类固醇、血管紧张素转换酶抑制剂、钙通道阻滞剂和β受体阻滞剂似乎对儿科心肌病入院结局均有有益影响。每组中的特定药物有不同的作用。
