The Factors for Postoperative Peritoneal Dialysis Treatment in Infants after Congenital Cardiac Procedure  

作　　者：Xiaofeng Wang Chenyu Li Xia Li Zhongyuan Lu Xu Wang 

机构地区：[1]Department of Pediatric Intensive Care Unit,National Center for Cardiovascular Disease and Fuwai Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing,100037,China

出　　处：《Congenital Heart Disease》2024年第6期617-626,共10页先天性心脏病(英文)

基　　金：supported by the Artificial Intelligence and Information Application Foundation of Fuwai Hospital,Chinese Academy of Medical Sciences(grant number:2024-AI17).

摘　　要：Objectives:Fluid overload is common after congenital cardiac surgeries.This requires early application of peritoneal dialysis(PD)in infants to improve surgical outcomes.The objective of this study is to ascertain the factors correlated with the necessity for PD in infants,thereby informing the prophylactic placement of PD catheters intraoperatively.Methods:This was a single-center retrospective study.Infants aged three months or younger who underwent congenital cardiac procedures at the Fuwai Hospital between 2021 and 2022 were included.Patients with chronic renal failure or without RACHS-1 categories were excluded.Based on whether postoperative PD treatment was performed,the patients were classified into PD and non-PD groups.Preoperative and intraoperative parameters were compared between the groups to identify factors for postoperative PDtreatment.Results:A total of 405 eligible patients were enrolled,with 35 and 370 patients allocated to the PD and non-PD groups.Multivariable analyses revealed that age(OR 0.563,95%CI 0.348–0.911,p=0.019),preoperative cystatin C level(OR 1.028,95%CI 1.003–1.053,p=0.03),cardiopulmonary bypass(CPB)minutes(OR 1.015;95%CI 1.006–1.024,p=0.001)and blood lactate level after weaning from CPB(OR 1.453,95%CI 1.173–1.800,p=0.001)were predictors for PD treatment.The ROC curve determined the following cutoff points for postoperative PD treatment:age less than 1 month,cystatin C level above 1.36 mg/L,CPB duration exceeding 130 min and blood lactate levels greater than 4 mmol/L.The multiple ROC curve demonstrated a sensitivity of 0.875,specificity of 0.826 and an area under the curve of 0.902.Conclusions:To facilitate the initiation of postoperative PDtreatment,it is advised that intraoperative prophylactic PDcatheterization be concurrently performed in patients presenting with all four identified factors.

关 键 词：Peritoneal dialysis congenital heart disease surgery INFANT 

分 类 号：R65[医药卫生—外科学]