Department of Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Department of Pediatric Cardiac Critical Care, Dell Children's Medical Center, Austin, Texas, USA.
JPEN J Parenter Enteral Nutr. 2024 May;48(4):469-478. doi: 10.1002/jpen.2616. Epub 2024 Feb 28.
Poor weight gain has been identified as an independent risk factor for increased surgical morbidity and mortality for patients with single-ventricle physiology undergoing staged surgical palliation. Conversely, excessive weight gain has also emerged as an independent risk factor predicting increased morbidity and mortality in a single-center study. Given this novel single-center concept, we investigated the impact of excessive weight on patients with single-ventricle physiology undergoing bidirectional Glenn palliation in a multicenter study model.
Patients from the Pediatric Heart Network Single Ventricle Reconstruction Trial (n = 387) were analyzed in a retrospective cohort study examining the independent effect of weight percentile on intensive care unit (ICU) length of stay (LOS) and ventilator days. Locally estimated scatterplot smoothing (LOESS) regression was used to plot weight-for-length (WFL) percentiles by ICU LOS and ventilator days. Unadjusted and adjusted ordinal regression was used to model ICU LOS and ventilator days.
Scatterplots and LOESS regression curves demonstrated increasing ICU LOS and ventilator days for increasing WFL percentiles. Unadjusted ordinal regression analysis of ICU LOS demonstrated a trend of increasing ICU LOS for increasing WFL percentiles that was not statistically significant (P = 0.11). A similar trend was demonstrated in adjusted ordinal regression that was not statistically significant (P = 0.48). Unadjusted and adjusted ordinal regression analysis of ventilator days did not reach statistical significance (P = 0.07).
Excessive weight gain has a clinically relevant but not statistically significant association with increased ICU LOS and ventilator days for those patients in the >90th WFL percentile for age.
对于接受分阶段手术姑息治疗的单心室生理患者，体重增加不良已被确定为手术发病率和死亡率增加的独立危险因素。相反，在一项单中心研究中，体重过度增加也已成为预测发病率和死亡率增加的独立危险因素。鉴于这一新颖的单中心概念，我们在多中心研究模型中调查了体重过度对接受双向 Glenn 姑息治疗的单心室生理患者的影响。
在回顾性队列研究中分析了来自儿科心脏网络单心室重建试验（n=387）的患者，该研究检查了体重百分位数对重症监护病房（ICU）住院时间（LOS）和呼吸机天数的独立影响。局部估计散点平滑（LOESS）回归用于绘制 ICU LOS 和呼吸机天数的体重-长度（WFL）百分位数。未调整和调整后的有序回归用于对 ICU LOS 和呼吸机天数进行建模。
散点图和 LOESS 回归曲线表明，随着 WFL 百分位数的增加，ICU LOS 和呼吸机天数增加。ICU LOS 的未调整有序回归分析显示，随着 WFL 百分位数的增加，ICU LOS 呈增加趋势，但无统计学意义（P=0.11）。调整后的有序回归也显示出相似的趋势，但无统计学意义（P=0.48）。呼吸机天数的未调整和调整后的有序回归分析均未达到统计学意义（P=0.07）。
对于体重超过年龄第 90 个 WFL 百分位数的患者，体重过度增加与 ICU LOS 和呼吸机天数增加具有临床相关性，但无统计学意义。
