Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Jiangdong South No. 8 Road, 210008, Nanjing, China.
BMC Pediatr. 2021 Jan 25;21(1):50. doi: 10.1186/s12887-021-02513-6.
We aimed to study the effectiveness of preoperative thyroid hormone levels in predicting intensive care unit (ICU) mortality after cardiopulmonary bypass (CPB) in infants with congenital heart disease (CHD).
We retrospectively reviewed and analyzed data from 133 patients younger than 3 months old who underwent cardiac surgery with CPB from June 2017 to November 2019. ICU mortality prediction was assessed by multivariate binary logistic regression analysis and area under the curve (AUC) analysis.
Non-survivors were younger (17.46 ± 17.10 days vs. 38.63 ± 26.87 days, P = 0.006), with a higher proportion of neonates (9/13 vs. 41/120, P = 0.017) and a higher proportion of individuals with a Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1) score ≥ 4 (8/13 vs. 31/120, P = 0.020). No significant difference was found in CPB and aortic cross-clamping (ACC) time. The levels of free triiodothyronine (FT3) (3.91 ± 0.99 pmol/L vs. 5.11 ± 1.55 pmol/L, P = 0.007) and total triiodothyronine (TT3) (1.55 ± 0.35 nmol/L vs. 1.90 ± 0.57 nmol/L, P = 0.032) were higher in survivors than in non-survivors. In the ICU mortality prediction assessment, FT3 was an independent mortality predictor and showed a high AUC (0.856 ± 0.040).
The preoperative FT3 level was a powerful and independent predictor of ICU mortality after CPB in infants with CHD younger than 3 months old.
我们旨在研究甲状腺激素水平术前对婴儿先天性心脏病（CHD）体外循环（CPB）后重症监护病房（ICU）死亡率的预测作用。
我们回顾性分析了 2017 年 6 月至 2019 年 11 月期间 133 名接受 CPB 心脏手术的 3 个月以下婴儿的数据。采用多变量二项逻辑回归分析和曲线下面积（AUC）分析评估 ICU 死亡率预测。
非存活组年龄较小（17.46±17.10 天 vs. 38.63±26.87 天，P=0.006），新生儿比例较高（9/13 vs. 41/120，P=0.017），风险调整先天性心脏手术-1（RACHS-1）评分≥4 的个体比例较高（8/13 vs. 31/120，P=0.020）。CPB 和主动脉阻断（ACC）时间无显著差异。游离三碘甲状腺原氨酸（FT3）（3.91±0.99 pmol/L vs. 5.11±1.55 pmol/L，P=0.007）和总三碘甲状腺原氨酸（TT3）（1.55±0.35 nmol/L vs. 1.90±0.57 nmol/L，P=0.032）水平在存活组中较高。在 ICU 死亡率预测评估中，FT3 是独立的死亡率预测因子，具有较高的 AUC（0.856±0.040）。
对于 3 个月以下患有 CHD 的婴儿，CPB 后 ICU 死亡率的术前 FT3 水平是一个有力且独立的预测因子。
