Both authors: German Paediatric Heart Centre, Children's Hospital, University Hospital Bonn, Bonn, Germany.
Crit Care Explor. 2024 Oct 21;6(10):e1170. doi: 10.1097/CCE.0000000000001170. eCollection 2024 Oct 1.
Postoperative thrombosis is a significant complication in pediatric cardiac surgery patients, contributing to morbidity and mortality. Identifying clinical factors associated with thrombosis can improve patient outcomes by guiding early detection and intervention.
This study aimed to assess factors associated with postoperative thrombosis or thromboembolism in pediatric patients under 12 months old who underwent surgery for congenital heart disease (CHD). Design, Setting, and Participants: This retrospective cohort study analyzed electronic medical records from pediatric patients admitted to the Pediatric Cardiovascular Intensive Care Unit (PCICU) at the German Paediatric Heart Center, Bonn, between March 1, 2020, and March 1, 2021. A total of 197 children under 12 months old who underwent cardiac surgery were included in the analysis.
Thrombosis was diagnosed postoperatively using imaging modalities such as ultrasound, echocardiography, and computed tomography. The primary outcome was the incidence of thrombosis and its association with clinical factors such as age, central venous catheter (CVC) duration, CRP levels, and D-dimer levels.
Among 197 patients, the incidence of thrombosis was 8.63%, predominantly venous (70.6%). Initial associations were observed between thrombosis and younger age, lower body weight, higher hematocrit, cyanosis, longer central venous catheter (CVC) use, and elevated C-reactive protein (CRP) and d-dimer levels. Receiver operating characteristic analysis indicated a higher risk in patients with d-dimer levels above 5.47 mg/L. The stepwise multiregression analysis identified longer CVC duration in situ (β = 0.553; p < 0.001), higher CRP levels (β = 0.217; p = 0.022), and younger age at admission (β = -0.254; p = 0.006) as significant predictors of thrombosis. Decision tree analysis identified CVC use longer than 12.5 days and CRP levels above 118.01 mg/L as the most critical risk factors.
Postoperative thrombosis is a notable risk in pediatric CHD patients, particularly in neonates. Prolonged CVC use and elevated CRP levels are critical risk factors. Routine monitoring of D-dimer and CRP levels, along with timely sonographic screening, can aid early thrombosis detection and intervention. Further research is warranted to optimize thrombosis prevention strategies in this population.
术后血栓形成是儿科心脏手术患者的一个严重并发症，会导致发病率和死亡率升高。确定与血栓形成相关的临床因素可以通过指导早期检测和干预来改善患者的预后。
本研究旨在评估在因先天性心脏病（CHD）接受手术的 12 个月以下儿童患者中，与术后血栓形成或血栓栓塞相关的因素。
设计、设置和参与者：这是一项回顾性队列研究，分析了 2020 年 3 月 1 日至 2021 年 3 月 1 日期间在德国儿科心脏中心儿科心血管重症监护病房（PCICU）住院的儿科患者的电子病历。共纳入了 197 名 12 个月以下接受心脏手术的儿童患者进行分析。
术后通过超声、超声心动图和计算机断层扫描等影像学手段诊断血栓形成。主要结局是血栓形成的发生率及其与年龄、中心静脉导管（CVC）使用时间、C 反应蛋白（CRP）水平和 D-二聚体水平等临床因素的关联。
在 197 名患者中，血栓形成的发生率为 8.63%，主要为静脉血栓形成（70.6%）。最初的关联是在年龄较小、体重较低、血细胞比容较高、发绀、CVC 使用时间较长以及 CRP 和 D-二聚体水平升高的患者中观察到的。受试者工作特征分析表明，D-二聚体水平高于 5.47mg/L 的患者风险更高。逐步多元回归分析确定了原位 CVC 持续时间较长（β=0.553；p<0.001）、CRP 水平较高（β=0.217；p=0.022）和入院时年龄较小（β=-0.254；p=0.006）是血栓形成的显著预测因素。决策树分析确定 CVC 使用时间超过 12.5 天和 CRP 水平超过 118.01mg/L 是最关键的危险因素。
术后血栓形成是儿科 CHD 患者的一个显著风险，尤其是在新生儿中。CVC 使用时间延长和 CRP 水平升高是关键的危险因素。常规监测 D-二聚体和 CRP 水平，并及时进行超声筛查，可以帮助早期发现血栓形成并进行干预。需要进一步研究以优化该人群的血栓预防策略。
