Pediatric Institute, Department of Cardiology, Cleveland Clinic Children's, Cleveland, OH.
Pediatric Institute, Department of Pediatric Critical Care, Cleveland Clinic Children's, Cleveland, OH.
Pediatr Crit Care Med. 2023 May 1;24(5):391-398. doi: 10.1097/PCC.0000000000003190. Epub 2023 Feb 21.
Greater congenital heart disease (CHD) complexity is associated with lower health-related quality of life (HRQOL). There are no data on the association between surgical and ICU factors and HRQOL in CHD survivors. This study assess the association between surgical and ICU factors and HRQOL in child and adolescent CHD survivors.
This was a corollary study of the Pediatric Cardiac Quality of Life Inventory (PCQLI) Testing Study.
Eight pediatric hospitals participating in the PCQLI Study.
Patients in the study had the Fontan procedure, surgery for tetralogy of Fallot (TOF), and transposition of the great arteries (TGAs).
Surgical/ICU explanatory variables were collected by reviewing the medical records. Primary outcome variables (PCQLI Total patient and parent scores) and covariates were obtained from the Data Registry. General linear modeling was used to create the multivariable models. There were 572 patients included: mean ± sd of age 11.7 ± 2.9 years; CHD Fontan 45%, TOF/TGA 55%; number of cardiac surgeries 2 (1-9); and number of ICU admissions 3 (1-9). In multivariable models, lowest body temperature on cardiopulmonary bypass (CPB) was negatively associated with patient total score (p < 0.05). The total number of CPB runs was negatively associated with parent-reported PCQLI Total score (p < 0.02). Cumulative days on an inotropic/vasoactive drug in the ICU was negatively associated with all patient-/parent-reported PCQLI scores (p < 0.04). Neurological deficit at discharge was negatively associated with parent-reported PCQLI total score (p < 0.02). The variance explained by these factors ranged from 24% to 29%.
Surgical/ICU factors, demographic, and medical care utilization variables explain a low-to-moderate amount of variation in HRQOL. Research is needed to determine whether modification of these surgical and ICU factors improves HRQOL, and to identify other factors that contribute to unexplained variability.
先天性心脏病（CHD）的复杂性越大，与健康相关的生活质量（HRQOL）越低。目前尚无关于CHD 幸存者手术和 ICU 因素与 HRQOL 之间关系的数据。本研究评估了儿童和青少年 CHD 幸存者手术和 ICU 因素与 HRQOL 之间的关系。
这是儿科心脏生活质量量表（PCQLI）测试研究的一个推论研究。
参与 PCQLI 研究的 8 家儿科医院。
研究中的患者接受了 Fontan 手术、法洛四联症（TOF）手术和大动脉转位（TGA）手术。
通过查阅病历收集手术/ICU 解释变量。主要结局变量（PCQLI 患者和家长总分）和协变量来自数据登记处。使用广义线性模型建立多变量模型。共纳入 572 例患者：年龄 11.7 ± 2.9 岁；CHD Fontan 45%，TOF/TGA 55%；心脏手术次数 2（1-9）；ICU 入住次数 3（1-9）。在多变量模型中，体外循环（CPB）时最低体温与患者总分呈负相关（p<0.05）。CPB 运行总次数与家长报告的 PCQLI 总分呈负相关（p<0.02）。ICU 内使用正性肌力/血管活性药物的累积天数与所有患者/家长报告的 PCQLI 评分呈负相关（p<0.04）。出院时的神经功能缺损与家长报告的 PCQLI 总分呈负相关（p<0.02）。这些因素解释的方差范围为 24%至 29%。
手术/ICU 因素、人口统计学和医疗保健利用变量解释了 HRQOL 的低到中度变化。需要研究是否可以通过改变这些手术和 ICU 因素来改善 HRQOL，并确定其他导致无法解释的变化的因素。
