Pulmonary infection after cardiopulmonary bypass surgery in children: a risk estimation model in China

Chunnian Ren,Yonggang Li,Chun Wu,Zhengxia Pan,Quan Wang

doi:10.1186/s13019-021-01450-w

Abstract

ObjectivesThe occurrence of pulmonary infection after congenital heart disease (CHD) surgery can lead to significant increases in intensive care in cardiac intensive care unit (CICU) retention time, medical expenses, and risk of death risk. We hypothesized that patients with a high risk of pulmonary infection could be screened out as early after surgery. Hence, we developed and validated the first risk prediction model to verify our hypothesis.MethodsPatients who underwent CHD surgery from October 2012 to December 2017 in the Children’s Hospital of Chongqing Medical University were included in the development group, while patients who underwent CHD surgery from December 2017 to October 2018 were included in the validation group. The independent risk factors associated with pulmonary infection following CHD surgery were screened using univariable and multivariable logistic regression analyses. The corresponding nomogram prediction model was constructed according to the regression coefficients. Model discrimination was evaluated by the area under the receiver operating characteristic curve (ROC) (AUC), and model calibration was conducted with the Hosmer-Lemeshow test.ResultsThe univariate and multivariate logistic regression analyses identified the following six independent risk factors of pulmonary infection after cardiac surgery: age, weight, preoperative hospital stay, risk-adjusted classification for congenital heart surgery (RACHS)-1 score, cardiopulmonary bypass time and intraoperative blood transfusion. We established an individualized prediction model of pulmonary infection following cardiopulmonary bypass surgery for CHD in children. The model displayed accuracy and reliability and was evaluated by discrimination and calibration analyses. The AUCs for the development and validation groups were 0.900 and 0.908, respectively, and the P-values of the calibration tests were 0.999 and 0.452 respectively. Therefore, the predicted probability of the model was consistent with the actual probability.ConclusionsIdentified the independent risk factors of pulmonary infection after cardiopulmonary bypass surgery. An individualized prediction model was developed to evaluate the pulmonary infection of patients after surgery. For high-risk patients, after surgery, targeted interventions can reduce the risk of pulmonary infection.

Highlights

Congenital heart disease (CHD) is the most common birth defect worldwide [1].Most CHD patients require surgical treatment
An individualized prediction model was developed to evaluate the pulmonary infection of patients after surgery
For high-risk patients, after surgery, targeted interventions can reduce the risk of pulmonary infection

Summary

Introduction

Congenital heart disease (CHD) is the most common birth defect worldwide [1].Most CHD patients require surgical treatment. Hospital-acquired infections (HAIs) are a major cause of morbidity and mortality in paediatric patients undergoing cardiac surgery [2, 3]. Pulmonary infection results in significant morbidity (e.g., increased antibiotic usage, prolonged hospital and intensive care unit (ICU) stays, and prolonged periods of mechanical ventilation and inotropic support), which contributes to an increase in mortality [2, 4]. Secondary ischaemiareperfusion injury, hypothermia and surgical trauma can induce supplementary cascade reactions, the release of endotoxins, the activation of leukocytes and vascular endothelial cells, and the release of inflammatory cytokines, leading to a temporary immunosuppressive state [5, 6]. During the process of postoperative recovery, this immunosuppressive state leaves children vulnerable to infection and increases the risk of HAIs [2]

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