Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45229, USA.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA.
Crit Care. 2023 May 20;27(1):193. doi: 10.1186/s13054-023-04494-7.
Multiple organ dysfunction syndrome (MODS) is an important cause of post-operative morbidity and mortality for children undergoing cardiac surgery requiring cardiopulmonary bypass (CPB). Dysregulated inflammation is widely regarded as a key contributor to bypass-related MODS pathobiology, with considerable overlap of pathways associated with septic shock. The pediatric sepsis biomarker risk model (PERSEVERE) is comprised of seven protein biomarkers of inflammation and reliably predicts baseline risk of mortality and organ dysfunction among critically ill children with septic shock. We aimed to determine if PERSEVERE biomarkers and clinical data could be combined to derive a new model to assess the risk of persistent CPB-related MODS in the early post-operative period.
This study included 306 patients < 18 years old admitted to a pediatric cardiac ICU after surgery requiring cardiopulmonary bypass (CPB) for congenital heart disease. Persistent MODS, defined as dysfunction of two or more organ systems on postoperative day 5, was the primary outcome. PERSEVERE biomarkers were collected 4 and 12 h after CPB. Classification and regression tree methodology were used to derive a model to assess the risk of persistent MODS.
The optimal model containing interleukin-8 (IL-8), chemokine ligand 3 (CCL3), and age as predictor variables had an area under the receiver operating characteristic curve (AUROC) of 0.86 (0.81-0.91) for differentiating those with or without persistent MODS and a negative predictive value of 99% (95-100). Ten-fold cross-validation of the model yielded a corrected AUROC of 0.75 (0.68-0.84).
We present a novel risk prediction model to assess the risk for development of multiple organ dysfunction after pediatric cardiac surgery requiring CPB. Pending prospective validation, our model may facilitate identification of a high-risk cohort to direct interventions and studies aimed at improving outcomes via mitigation of post-operative organ dysfunction.
多器官功能障碍综合征（MODS）是接受体外循环（CPB）心脏手术的儿童术后发病率和死亡率的重要原因。失调的炎症被广泛认为是与旁路相关的 MODS 病理生理学的关键因素，与败血症性休克相关的途径有很大的重叠。儿科败血症生物标志物风险模型（PERSEVERE）由七个炎症蛋白生物标志物组成，可可靠地预测患有败血症性休克的危重病儿童的基线死亡率和器官功能障碍风险。我们旨在确定 PERSEVERE 生物标志物和临床数据是否可以组合以得出一种新模型，以评估术后早期持续 CPB 相关 MODS 的风险。
这项研究包括 306 名年龄小于 18 岁的患者，这些患者在因先天性心脏病需要 CPB 手术后入住儿科心脏 ICU。持续性 MODS 定义为术后第 5 天出现两个或多个器官系统功能障碍。CPB 后 4 小时和 12 小时采集 PERSEVERE 生物标志物。使用分类和回归树方法来建立评估持续性 MODS 风险的模型。
包含白细胞介素 8（IL-8）、趋化因子配体 3（CCL3）和年龄作为预测变量的最佳模型，在区分有无持续性 MODS 患者方面具有 0.86（0.81-0.91）的接收者操作特征曲线（AUROC），阴性预测值为 99%（95-100）。该模型的 10 倍交叉验证产生了校正的 AUROC 为 0.75（0.68-0.84）。
我们提出了一种新的风险预测模型，用于评估需要 CPB 的儿科心脏手术后发生多器官功能障碍的风险。在进行前瞻性验证之前，我们的模型可以帮助确定高风险人群，以指导干预措施，并通过减轻术后器官功能障碍来开展改善预后的研究。
