- 作者：Monique Radman ; Ricardo Mack ; Joaquin Barnoya ; Aldo Casta帽eda ; Monica Rosales ; Anthony Azakie ; Nilesh Mehta ; Roberta Keller ; Sanjeev Datar ; Peter Oishi ; Jeffrey Fineman
- 关键词：BMI ; body mass index ; BNP ; B-type natriuretic peptide ; CHD ; congenital heart disease ; CI ; confidence interval ; CPB ; cardiopulmonary bypass ; ICU ; intensive care unit ; LOS ; length of stay ; PCICU ; pediatric cardiac intensive care unit ; UCSF ; University of California at San Francisco ; UNICAR ; La Unidad de Cirugia Cardiovascular de Guatemala ; WHO ; World Health Organization ; TSFZ ; triceps skin-fold-for-age z score
- 刊名：The Journal of Thoracic and Cardiovascular Surgery
- 出版年：January, 2014
- 年：2014
- 卷：147
- 期：1
- 页码：442-450
- 全文大小：234 K
Objective
The objective of this study was to determine the association between preoperative nutritional status and postoperative outcomes in children undergoing surgery for congenital heart defects (CHD).Methods
Seventy-one patients with CHD were enrolled in a prospective, 2-center cohort study. We adjusted for baseline risk differences using a standardized risk adjustment score for surgery for CHD. We assigned a World Health Organization z score for each subject鈥檚 preoperative triceps skin-fold measurement, an assessment of total body fat mass. We obtained preoperative plasma concentrations of markers of nutritional status (prealbumin, albumin) and myocardial stress (B-type natriuretic peptide [BNP]). Associations between indices of preoperative nutritional status and clinical outcomes were sought.
Results
Subjects had a median (interquartile range [IQR]) age of 10.2 (33) months. In the University of California at San Francisco (UCSF) cohort, duration of mechanical ventilation (median, 19 hours; IQR, 29 hours), length of intensive care unit stay (median, 5 days; IQR 5 days), duration of any continuous inotropic infusion (median, 66 hours; IQR 72 hours), and preoperative BNP levels (median, 30 pg/mL; IQR, 75 pg/mL) were associated with a lower preoperative triceps skin-fold z score (P聽<聽.05). Longer duration of any continuous inotropic infusion and higher preoperative BNP levels were also associated with lower preoperative prealbumin (12.1 卤 0.5 mg/dL) and albumin (3.2 卤 0.1; P聽<聽.05) levels.
Conclusions
Lower total body fat mass and acute and chronic malnourishment are associated with worse clinical outcomes in children undergoing surgery for CHD at UCSF, a resource-abundant institution. There is an inverse correlation between total body fat mass and BNP levels. Duration of inotropic support and BNP increase concomitantly as measures of nutritional status decrease, supporting the hypothesis that malnourishment is associated with decreased myocardial function.