Escala de riesgo Aristóteles como factor predictor de mortalidad en el cierre quirúrgico de persistencia de ductus arterioso en prematuros

Abstract

Introduction and objectivesPatent ductus arteriosus is a very common diagnosis in pre-term infants. Surgical closure is a therapeutic option. An attempt is made to identify pre-operative risk factors for mortality, and the usefulness of the Aristotle score to predict mortality. MethodA retrospective analysis was conducted on all patients under 1500g birth weight undergoing surgical closure at our hospital between January 2008 and December 2013. Perioperative data were collected, and a logistic regression model was used for analysis. ResultsOf the 100 patients reviewed, 59 were male infants, and the mean gestational age and birth weight was 26.1±1.8 weeks and 823.5±191.9g, respectively. The mean Aristotle Comprehensive Complexity Score was 14.02±2.48. The median age at surgery was 15.5 days, and 19 (19%) patients died while in hospital.In the multivariate analysis for mortality, patients with a higher Aristotle Comprehensive Complexity Score (OR 2.8 (95% confidence interval, 1.73-4.59); P=.0001) had a higher mortality. Among the risk factors, the Aristotle Comprehensive Complexity Score showed the largest area under curve (0.904) in the receiver-operating curve analysis. The group with a greater than or equal to 15 score had a higher risk of mortality. ConclusionsMortality associated with surgical closure of patent ductus arteriosus is related to prematurity status of the patient not to surgery itself. Aristotle Comprehensive Complexity Score is the most useful independent predictor of mortality. The patient group with greater than or equal to 15 score had an increased risk of in-hospital mortality. In this selected sub-group, a conservative treatment might be the best option.