儿童心力衰竭基于年龄的分类及预后：一项回顾性多中心队列研究的结果
Age-Based Classification and Outcomes in Pediatric Heart Failure: Findings From a Retrospective Multicenter Cohort Study.
作者信息
Yuan Yuxing, Pan Bo, Wang Fangjie, Chen Zhi, Guo Ying, Shen Xing, Liang Xuecun, Liang Yanyan, Xing Yanlin, Zhang HuiLi, Zhang Yingqian, Xie Chunhong, Li Li, Huang Zhilin, Sun Huichao, Zheng Min, Liu Lingjuan, Lv Tiewei, Li Zipu, Liang Xiaohua, Tian Jie
机构信息
Department of Cardiology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Key Laboratory of Children's Important Organ Development and Diseases of Chongqing Municipal Health Commission, National Clinical Key Cardiovascular Specialty Children's Hospital of Chongqing Medical University Chongqing China.
Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital.
出版信息
J Am Heart Assoc. 2025 Feb 18;14(4):e038129. doi: 10.1161/JAHA.124.038129. Epub 2025 Feb 8.
BACKGROUND
Although heart failure is a well-known major global public health concern, the general understanding of the clinical status of pediatric heart failure (PHF) is inadequate. Therefore, this study aims to enhance the general understanding of clinical characteristics across different PHF age groups and provide references for improving PHF treatment strategies.
METHODS
This multicenter retrospective cohort study involved patients from 20 Chinese provinces, primarily including hospitalized patients (aged ≤18 years) diagnosed with heart failure between January 2013 and December 2022. The study subjects were categorized into 4 groups: neonatal, infant and toddler, young children, and adolescent.
RESULTS
Herein, 2903 hospitalized patients with PHF were included. Significant differences were observed across age groups in clinical characteristics, auxiliary examination results, comorbid diagnoses, and hospitalization outcomes. After adjusting for covariates, the odds of in-hospital death were significantly lower in the infant and toddler (odds ratio [OR], 0.46 [95% CI, 0.25-0.85]), young children (OR, 0.39 [95% CI, 0.18-0.85]), and adolescent (OR, 0.34 [95% CI, 0.13-0.87]) groups compared with the neonatal group. Furthermore, the odds of cardiovascular adverse events were significantly higher in the young children (OR, 1.91 [95% CI, 1.62-2.88]) and adolescent (OR, 2.16 [95% CI, 1.15-4.06]) groups compared with the neonatal group. Additionally, regarding the odds of a bad Ross class, the adolescent group had 1.85 times higher odds (95% CI, 1.11-3.09) compared with the neonatal group, 2.36 times (95% CI, 1.67-3.35) higher odds compared with the infant and toddler group, and 1.45 times (95% CI, 1.05-2.02) higher odds compared with the young children group (<0.05).
CONCLUSIONS
This study emphasizes the importance of age-specific stratification in PHF management, revealing distinct clinical and prognostic differences across various developmental stages.
REGISTRATION
URL: https://www.chictr.org.cn. Unique identifier: ChiCTR2300078262.
背景
尽管心力衰竭是全球众所周知的主要公共卫生问题，但对小儿心力衰竭（PHF）临床状况的总体认识仍不足。因此，本研究旨在提高对不同PHF年龄组临床特征的总体认识，并为改进PHF治疗策略提供参考。
方法
这项多中心回顾性队列研究纳入了来自中国20个省份的患者，主要包括2013年1月至2022年12月期间诊断为心力衰竭的住院患者（年龄≤18岁）。研究对象分为4组：新生儿组、婴幼儿组、幼儿组和青少年组。
结果
本研究共纳入2903例住院的PHF患者。不同年龄组在临床特征、辅助检查结果、合并诊断和住院结局方面存在显著差异。在调整协变量后，婴幼儿组（比值比[OR]，0.46[95%置信区间，0.25 - 0.85]）、幼儿组（OR，0.39[95%置信区间，0.18 - 0.85]）和青少年组（OR，0.34[95%置信区间，0.13 - 0.87]）院内死亡的几率显著低于新生儿组。此外，幼儿组（OR，1.91[95%置信区间，1.62 - 2.88]）和青少年组（OR，2.16[95%置信区间，1.15 - 4.06]）心血管不良事件的几率显著高于新生儿组。此外，关于不良罗斯分级的几率，青少年组比新生儿组高1.85倍（95%置信区间，1.11 - 3.09），比婴幼儿组高2.36倍（95%置信区间，1.67 - 3.35），比幼儿组高1.45倍（95%置信区间，1.05 - 2.02）（<0.05）。
结论
本研究强调了在PHF管理中按年龄分层的重要性，揭示了不同发育阶段存在明显的临床和预后差异。
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