Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
BMJ Open. 2024 Mar 14;14(3):e076483. doi: 10.1136/bmjopen-2023-076483.
The objective of this study was to evaluate the early predictors of bacterial pneumonia infection in children with congenital heart disease (CHD) after cardiopulmonary bypass (CPB).
Retrospective study.
A freestanding tertiary paediatric hospital in China.
Patients admitted to the hospital due to CHD who underwent open-heart surgery.
We retrospectively reviewed and analysed data from 1622 patients with CHD after CPB from June 2018 to December 2020 at the Children's Hospital of Nanjing Medical University. Enrolled patients were assigned to an infection group or a non-infection group according to the presence of postoperative bacterial pneumonia infection, and the differences in clinical indicators were compared. Potential predictors were analysed by multivariate logistic regression analysis and area under the curve (AUC) analysis.
Among the 376 patients (23.2%) in the infection group, the three most common bacteria were in 67 patients (17.8%), in 63 patients (16.8%) and in 53 patients (14.1%). The infection group exhibited a lower weight (8.0 (6.0-11.5) kg vs 11.0 (7.5-14.5) kg, p<0.001). In the infection group, procalcitonin (PCT) (ng/mL: 4.72 (1.38-9.52) vs 1.28 (0.47-3.74), p<0.001) and C reactive protein (CRP) (mg/L: 21.0 (12.1-32.0) vs 17.0 (10.0-27.0), p<0.001) levels were significantly greater than those in the non-infection group. Binary logistic regression analysis revealed that weight, PCT and CRP were independent risk factors for pulmonary bacterial infection after CPB. The AUCs of weight, PCT, CRP and PCT+CRP for predicting pulmonary bacterial infection after CPB were 0.632 (95% CI 0.600 to 0.664), 0.697 (95% CI 0.667 to 0.727), 0.586 (95% CI 0.554 to 0.618) and 0.694 (95% CI 0.664 to 0.724), respectively, and the cut-off values were ≤10.25 kg, ≥4.25 ng/mL, ≥6.50 mg/L and ≥0.20, respectively. The sensitivities were 69.7%, 54.0%, 93.9% and 70.2%, and the specificities were 53.5%, 77.7%, 19.4% and 59.1%, respectively.
In our study, weight, PCT and CRP were found to be independent predictors of pulmonary bacterial infection after CPB. Moreover, PCT was the most specific predictor, and CRP was the most sensitive independent predictor that might be beneficial for the early diagnosis of pulmonary bacterial infection after CPB in patients with CHD.
本研究旨在评估体外循环（CPB）后先天性心脏病（CHD）患儿细菌性肺炎感染的早期预测因素。
回顾性研究。
中国一家独立的三级儿科医院。
因 CHD 入住医院并接受心脏直视手术的患者。
我们回顾性分析了 2018 年 6 月至 2020 年 12 月南京医科大学儿童医院 1622 例 CPB 后 CHD 患者的数据。根据术后细菌性肺炎感染的存在，将纳入的患者分为感染组或非感染组，并比较临床指标的差异。采用多变量逻辑回归分析和曲线下面积（AUC）分析潜在预测因素。
在 376 例（23.2%）感染组患者中，最常见的三种细菌分别为 67 例（17.8%）、 63 例（16.8%）和 53 例（14.1%）。感染组的体重较低（8.0（6.0-11.5）kg 比 11.0（7.5-14.5）kg，p<0.001）。在感染组中，降钙素原（PCT）（ng/mL：4.72（1.38-9.52）比 1.28（0.47-3.74），p<0.001）和 C 反应蛋白（CRP）（mg/L：21.0（12.1-32.0）比 17.0（10.0-27.0），p<0.001）水平显著高于非感染组。二元逻辑回归分析显示，体重、PCT 和 CRP 是 CPB 后肺部细菌感染的独立危险因素。体重、PCT、CRP 和 PCT+CRP 预测 CPB 后肺部细菌感染的 AUC 分别为 0.632（95%CI 0.600-0.664）、0.697（95%CI 0.667-0.727）、0.586（95%CI 0.554-0.618）和 0.694（95%CI 0.664-0.724），截断值分别为≤10.25kg、≥4.25ng/mL、≥6.50mg/L 和≥0.20。敏感度分别为 69.7%、54.0%、93.9%和 70.2%，特异度分别为 53.5%、77.7%、19.4%和 59.1%。
在本研究中，我们发现体重、PCT 和 CRP 是 CPB 后肺部细菌感染的独立预测因素。此外，PCT 是最特异的预测指标，CRP 是最敏感的独立预测指标，可能有助于 CHD 患者 CPB 后肺部细菌感染的早期诊断。
