Risk prediction for severe pneumonia following congenital heart disease surgery in children

Chunnian REN; Chun WU; Zhengxia PAN; Yonggang LI

doi:10.16016/j.1000-5404.202007232

您当前的位置：

首页 >

文章列表页 >

Risk prediction for severe pneumonia following congenital heart disease surgery in children

Clinical studies on cardiac surgery | 更新时间：2026-01-09

- Risk prediction for severe pneumonia following congenital heart disease surgery in children
- Journal of Third Military Medical University Vol. 43, Issue 2, Pages: 109-116(2021)
- 作者机构：
  
  400014 重庆，重庆医科大学附属儿童医院胸心外科，儿童发育疾病研究教育部重点实验室
- 作者简介：
- 基金信息：
- DOI：10.16016/j.1000-5404.202007232
  CLC： R541.1;R619;R725.631
- Received：29 July 2020，
  
  Revised：2020-10-25，
  
  Published：30 January 2021
- 稿件说明：
移动端阅览
Chunnian REN, Chun WU, Zhengxia PAN, et al. Risk prediction for severe pneumonia following congenital heart disease surgery in children[J]. Journal of Third Military Medical University, 2021, 43(2): 109-116.
DOI：

Chunnian REN, Chun WU, Zhengxia PAN, et al. Risk prediction for severe pneumonia following congenital heart disease surgery in children[J]. Journal of Third Military Medical University, 2021, 43(2): 109-116. DOI： 10.16016/j.1000-5404.202007232.

摘要

目的

建立并验证儿童先天性心脏病体外循环手术后发生重症肺炎的风险预测模型。

方法

将2014年10月至2017年12月于重庆医科大学附属儿童医院胸心外科确诊为先心病并接受体外循环下手术治疗的患者纳入建模组(

=1 415)，将2017年12月至2018年10月接受体外循环手术的患者纳入验证组(

=393)。采用单因素和多因素Logistic回归分析筛选体外循环术后发生重症肺炎的独立危险因素。根据回归系数建立相应的列线图。用受试者工作特征曲线(ROC)下的面积(AUC)及校准曲线来评价模型。

结果

单因素和多因素Logistic回归分析发现:年龄、体质量、术前住院时间、先天性心脏手术风险调整分级(RACHS-1评分)、体外循环时间是影响体外循环手术后重症肺炎的5个独立危险因素。根据5个独立危险因素，建立个体化预测模型。模型评价结果显示:建模组和验证组的AUC分别为0.943(95%

，0.929-0.954)和0.925(95%

，0.894-0.949)，校准试验的

值分别为0.592和0.256。

结论

本研究建立的个体化预测模型可较好地应用于评估先天性心脏病患儿体外循环术后发生重症肺炎的风险。

Abstract

Objective

To establish and validate a risk prediction model for severe pneumonia following cardiopulmonary bypass (CPB) in children with congenital heart disease.

Methods

All the children diagnosed with congenital heart disease and treated with CPB surgery in the Department of Thoracic Surgery

Children's hospital of Chongqing Medical University from October 2014 to December 2017 were assigned into the modeling group (

=1 415)

while those treated from December 2017 to October 2018 were enrolled into the validation group (

=393). The independent risk factors for severe pneumonia after surgery were screened using univariate and multivariate Logistic regression analysis

and the corresponding nomogram prediction model was constructed according to the regression coefficients. The receiver operating characteristic (ROC) curve and calibration curve were used respectively to evaluate the discriminant validity and calibration of the prediction model.

Results

The following 5 indicators were revealed to be the independent risk factors for severe pneumonia after CPB surgery: age

weight

preoperative hospital stay

score of Risk Adjustment in Congenital Heart Surgery-1 (RACHS-1) and time of cardiopulmonary bypass. Based on them

an individualized prediction model was established. The area under the curve (AUC) of the prediction model was 0.943 (95%

: 0.929-0.954) and 0.925 (95%

: 0.894-0.949) for the modeling and validation groups

indicating good discriminant validity. The

value of the calibration test was 0.592 and 0.256 for the 2 groups.

Conclusion

Our established individualized prediction model can be well used to evaluate the risk of severe pneumonia in children with congenital heart disease after CPB.

关键词

Keywords

references

VAN DER LINDE D, KONINGS E E, SLAGER M A, et al . Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis[J ] . J Am Coll Cardiol, 2011, 58(21): 2241-2247. DOI: 10.1016/j.jacc.2011.08.025.

LEVY I, OVADIA B, EREZ E, et al . Nosocomial infections after cardiac surgery in infants and children: incidence and risk factors[J ] . J Hosp Infect, 2003, 53(2): 111-116. DOI: 10.1053/jhin.2002.1359.

URREA M, PONS M, SERRA M, et al . Prospective incidence study of nosocomial infections in a pediatric intensive careunit[J ] . Pediatr Infect Dis J, 2003, 22(6): 490-494. DOI: 10.1097/01.inf.0000069758.00079.d3.

GUARDIA CAMÍ M T, JORDAN GARCÍA I, URREA AYALA M. Nosocomial infections in pediatric patients following cardiac surgery[J]. An Pediatr (Barc), 2008, 69(1): 34-38. DOI: 10.1157/13124216.

VALERA M, SCOLFARO C, CAPPELLO N, et al . Nosocomial infections in pediatric cardiac surgery, Italy[J ] . Infect Control Hosp Epidemiol, 2001, 22(12): 771-775. DOI: 10.1086/501861.

《中华儿科杂志》编辑委员会, 中华医学会儿科学分会呼吸学组, 中华医学会儿科学分会急救学组, 等.儿童医院获得性肺炎管理方案(2010版)[J].中华儿科杂志, 2011, 49(2): 106-115. DOI:10.3760/cma.j.issn.0578-1310.2011.02.008.

Editorial Board of Chinese Journal of Pediatrics, Subspecialty Group of Respiratory Diseases of CMA, The Subspecialty Group of Emergency of CMA, et al . The management of hospital acquired pneumonia in children (2010)[J ] . Chin J Pediatr, 2011, 49(2): 106-115. DOI:10.3760/cma.j.issn.0578-1310.2011.02.008.

中华医学会儿科学分会呼吸学组, 《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南(2013修订)(下)[J].中华儿科杂志, 2013, 51(11):856-862. DOI: 10.3760/cma.j.issn.0578-1310.2013.11.012.

Department of Respiratory Medicine of Pediatrics Branch of CMA, Editorial Board of Chinese Journal of Pediatrics. Guidelines for management of childhood community acquired pneumonia (for trial implementation) (Ⅱ)[J]. Chin J Pediatrics, 2013, 51(11): 856-862. DOI:10.3760/cma.j.issn.0578-1310.2013.11.012.

JENKINS K J. Risk adjustment for congenital heart surgery: the RACHS-1 method[J]. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2004, 7: 180-184. DOI: 10.1053/j.pcsu.2004.02.009.

LACOUR-GAYET F, CLARKE D, JACOBS J, et al . The Aristotle score: a complexity-adjusted method to evaluate surgical results[J ] . Eur J Cardiothorac Surg, 2004, 25(6): 911-924. DOI: 10.1016/j.ejcts.2004.03.027.

JENKINS K J, GAUVREAU K, NEWBURGER J W, et al . Consensus-based method for risk adjustment for surgery for congenital heart disease[J ] . J Thorac Cardiovasc Surg, 2002, 123(1): 110-118. DOI: 10.1067/mtc.2002.119064.

GARCÍA H, CERVANTES-LUNA B, GONZÁLEZ-CABELLO H, et al . Risk factors for nosocomial infections after cardiac surgery in newborns with congenital heart disease[J ] . Pediatr Neonatol, 2018, 59(4): 404-409. DOI: 10.1016/j.pedneo.2017.11.014.

STYNES S, KONSTANTINOU K, OGOLLAH R, et al . Clinical diagnostic model for sciatica developed in primary care patients with low back-related leg pain[J ] . PLoS ONE, 2018, 13(4): e0191852. DOI: 10.1371/journal.pone.0191852.

BARKER G M, O'BRIEN S M, WELKE K F, et al . Major infection after pediatric cardiac surgery: a risk estimationmodel[J ] . Ann Thorac Surg, 2010, 89(3): 8 43-850. DOI: 10.1016/j.athoracsur.2009.11.048.

杨立, 常云峰, 蔡继峰, 等.医疗损害责任纠纷原因分析:以医院、患者及社会为视角[J].中国司法鉴定, 2018(4): 32-36. DOI: 10.3969/j.issn.1671-2072.2018.04.006.

YANG L, CHANG Y F, CAI J F, et al . Analysis of the causes of medical disputes: from the aspects of hospitals, patients and the society[J ] . Chin J Forensic Sci, 2018(4): 32-36. DOI: 10.3969/j.issn.1671-2072.2018.04.006.

IASONOS A, SCHRAG D, RAJ G V, et al . How to build and interpret anomogram for cancer prognosis[J ] . J Clin Oncol, 2008, 26(8): 1364-1370. DOI: 10.1200/JCO.2007.12.9791.

TANG C W, LIU P Y, HUANG Y F, et al . Ventilator-associated pneumonia after pediatric cardiac surgery in southernTaiwan[J ] . J Microbiol Immunol Infect, 2009, 42(5): 413-419.

YU X D, CHEN M L, LIU X, et al . Risk factors of nosocomial infection after cardiac surgery in children with congenital heart disease[J ] . BMC Infect Dis, 2020, 20(1): 64. DOI: 10.1186/s12879-020-4769-6.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

No data

Related Author

No data

Related Institution

No data

⁰