Gao Peng, Wang Xu, Zhang Peiyao, Jin Yu, Bai Liting, Wang Wenting, Li Yixuan, Liu Jinping
Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Cardiovasc Med. 2022 Jun 2;9:887535. doi: 10.3389/fcvm.2022.887535. eCollection 2022.
Iron deficiency (ID) is common in patients undergoing cardiac surgery, which is associated with adverse outcomes. However, the relevance of ID in congenital heart disease is still unclear. This study aimed to investigate the characteristics of preoperative ID and its association with clinical outcomes in infants undergoing cardiac surgery with cardiopulmonary bypass.
In this retrospective study, 314 patients undergoing cardiac surgery were assigned into three groups according to their preoperative ID status. Absolute ID was defined by serum ferritin <12 μg/L, and functional ID was defined by serum ferritin level at 12-30 μg/L and transferrin saturation <20%. Baseline characteristics were compared between groups and multiple logistic regression was used to identify predictors for ID. The association between ID and clinical outcomes, including allogenic blood transfusion requirements, was also evaluated.
Among the 314 patients included, 32.5% were absolute ID and 28.7% were functional ID. Patients with absolute ID were more often of higher weight, cyanotic heart disease, and anemia. The presence of absolute ID was associated with an increase in postoperative blood transfusion (OR 1.837, 95% CI 1.016-3.321, = 0.044). There was no significant difference in postoperative morbidity, mortality, and the length of hospital stay.
Absolute ID was associated with preoperative anemia and cyanotic heart disease, and was an independent risk factor for postoperative blood transfusion. Further research should better explore the definition of ID and its impact on outcomes in pediatric cardiac surgery.
缺铁（ID）在接受心脏手术的患者中很常见，这与不良预后相关。然而，ID在先天性心脏病中的相关性仍不清楚。本研究旨在调查接受体外循环心脏手术的婴儿术前ID的特征及其与临床结局的关联。
在这项回顾性研究中，314例接受心脏手术的患者根据术前ID状态分为三组。绝对缺铁定义为血清铁蛋白<12μg/L，功能性缺铁定义为血清铁蛋白水平在12 - 30μg/L且转铁蛋白饱和度<20%。比较各组间的基线特征，并采用多因素逻辑回归分析确定缺铁的预测因素。还评估了缺铁与临床结局（包括异体输血需求）之间的关联。
在纳入的314例患者中，32.5%为绝对缺铁，28.7%为功能性缺铁。绝对缺铁的患者体重通常更高，患有青紫型心脏病和贫血。绝对缺铁与术后输血增加相关（比值比1.837，95%可信区间1.016 - 3.321，P = 0.044）。术后发病率、死亡率和住院时间无显著差异。
绝对缺铁与术前贫血和青紫型心脏病相关，是术后输血的独立危险因素。进一步的研究应更好地探索缺铁的定义及其对小儿心脏手术结局的影响。
