Huo Junming, Cheng Jie, Liu Chengjun, Fu Yueqiang, Xu Feng, Li Jing
Department of Critical Care Medicine, 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 Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China.
Department of Emergency, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China.
Front Pediatr. 2025 Mar 25;13:1494533. doi: 10.3389/fped.2025.1494533. eCollection 2025.
Capillary leak syndrome (CLS) is an urgent problem in postoperative patients, is challenging to diagnose early, and has a poor prognosis. We investigated a quick and convenient diagnostic indicator of secondary CLS in children after cardiopulmonary bypass (CPB).
We conducted this single-center, observational, prospective study in the Department of Critical Care Medicine at the Children's Hospital of Chongqing Medical University. All the data were collected within 24 h after cardiopulmonary bypass (CPB). The secondary CLS risk factors were determined using univariate and multivariate logistic regression analysis, and the cut-off point of secondary CLS was found by receiver operating characteristic (ROC) analysis.
Our study included two hundred four pediatric patients in the PICU after cardiopulmonary bypass (CPB). 42.65% (87/204) of patients were diagnosed with secondary CLS. The incidence of acute kidney injury (AKI) was 36.76% (75/204), and the mortality was 5.39% (11/204). Logistic analysis indicated that a pulmonary exudation on chest radiograph, a high thoracic fluid content (TFC) and a higher vasoactive inotropic score (VIS) were independent risk factors for secondary CLS [odds ratio [OR] 23.62, 95% confidence interval [CI] 7.20-90.41, < 0.001; OR 1.08, 95% CI 1.02-1.16, = 0.010; OR 1.06, 95% CI 1.01-1.14, = 0.049; respectively]. According to the ROC analysis, the cut-off point for the TFC was 52 (Ω).
The TFC plays a key role in the early prediction of secondary CLS in children after CPB, and this novel indicator may help clinicians initiate intensive treatment as early as possible.
毛细血管渗漏综合征（CLS）是术后患者面临的一个紧迫问题，早期诊断具有挑战性，且预后较差。我们研究了一种快速便捷的诊断小儿体外循环（CPB）后继发性CLS的指标。
我们在重庆医科大学附属儿童医院重症医学科进行了这项单中心、观察性、前瞻性研究。所有数据均在体外循环（CPB）后24小时内收集。使用单因素和多因素逻辑回归分析确定继发性CLS的危险因素，并通过受试者工作特征（ROC）分析找到继发性CLS的截断点。
我们的研究纳入了204例体外循环（CPB）后入住儿科重症监护病房（PICU）的患儿。42.65%（87/204）的患者被诊断为继发性CLS。急性肾损伤（AKI）的发生率为36.76%（75/204），死亡率为5.39%（11/204）。逻辑分析表明，胸部X线片上的肺部渗出、高胸液含量（TFC）和较高的血管活性药物评分（VIS）是继发性CLS的独立危险因素[比值比（OR）23.62，95%置信区间（CI）7.20 - 90.41，P < 0.001；OR 1.08，95% CI 1.02 - 1.16，P = 0.010；OR 1.06，95% CI 1.01 - 1.14，P = 0.049；分别]。根据ROC分析，TFC的截断点为52（Ω）。
TFC在小儿体外循环（CPB）后继发性CLS的早期预测中起关键作用，这一新型指标可能有助于临床医生尽早启动强化治疗。
