Postoperative Alanine Aminotransferase Levels Are Associated with Outcomes in Pediatric Patients Undergoing Total Cavopulmonary Connection
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Data Collection
2.3. Statistical Analysis
3. Results
3.1. Clinical Characteristics of Subjects Stratified by Maximal ALT Value within 48 h Post-TCPC
3.2. Univariate and Multivariate Logistic Analyses of Risk Factors Associated with High ALT Following TCPC Operation
3.3. ROC Analysis of Postoperative ALT in Predicting Reintubation or All-Cause Infection for Pediatric Patients Undergoing TCPC Operation
3.4. ROC Analysis of Postoperative ALT in Predicting Clinical Outcomes for Pediatric Patients Undergoing TCPC Operation
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | Normal-ALT Group (n = 134) | High-ALT Group (n = 122) | p-Value |
---|---|---|---|
Male (%) | 88 (65.7%) | 87 (71.3%) | 0.404 |
Female (%) | 46 (34.3%) | 35 (28.7%) | 0.404 |
Age (years) | 4.7 [3.7; 7.7] | 6.3 [3.9; 11.8] | 0.019 * |
Height (cm) | 105.0 [97.0; 122.0] | 109.5 [97.0; 143.0] | 0.179 |
Weight (kg) | 16.0 [14.0; 20.0] | 17.0 [14.0; 32.0] | 0.085 |
Preoperative WBC (10⁹/L) | 7.9 [6.6; 9.3] | 7.9 [6.4; 10.0] | 0.809 |
Preoperative hemoglobin (g/L) | 165.0 [154.0; 180.0] | 167.0 [154.0; 183.0] | 0.497 |
Preoperative platelet (10⁹/L) | 253.0 [208.0; 316.0] | 233.0 [189.0; 301.0] | 0.067 |
Preoperative creatinine (μmol/L) | 33.0 [26.9; 44.0] | 37.0 [30.0; 50.0] | 0.018 * |
Preoperative ALT (U/L) | 15.0 [12.0; 19.0] | 15.5 [13.0; 19.0] | 0.536 |
Preoperative total bilirubin (μmol/L) | 13.0 [9.2; 16.9] | 12.8 [10.3; 17.8] | 0.528 |
Preoperative direct bilirubin (μmol/L) | 3.7 [2.7; 4.8] | 4.3 [3.0; 5.8] | 0.035 * |
Preoperative fibrinogen (mg/dL) | 2.6 [2.3; 3.2] | 2.7 [2.4; 3.3] | 0.059 |
Cardiopulmonary bypass time (h) | 118.5 [88.0; 142.0] | 123.5 [91.0; 163.0] | 0.099 |
Aortic cross clamp time (h) | 47.0 [0.0; 67.0] | 48.5 [0.0; 84.0] | 0.516 |
Transfusion of RBC (U) | 2.0 [1.0; 3.0] | 3.0 [2.0; 6.0] | <0.001 ** |
eTCPC (%) | 49 (36.6%) | 47 (38.5%) | 0.846 |
TCPC fenestration (%) | 17 (12.7%) | 21 (17.2%) | 0.4 |
Maximal ALT within 48 h post-TCPC (U/L) | 20.0 [16.0; 25.0] | 379.0 [125.0; 1749.0] | <0.001 ** |
Circulatory fluid load 24 h post-TCPC (mL) | 104.8 [–91.0; 397.3] | 495.5 [20.0; 1170.0] | <0.001 ** |
Vasoactive inotropic score 24 h post-TCPC | 5.0 [4.0; 8.0] | 8.0 [5.0;15.0] | <0.001 ** |
Postoperative diastolic arterial pressure within 1 h post-TCPC (mmHg) | 58.0 [50.0; 65.0] | 55.5 [49.0; 62.0] | 0.251 |
Postoperative ICVP 1 h post-TCPC (mmHg) | 16.0 [13.0; 18.5] | 17.0 [15.0; 20.0] | 0.005 ** |
Postoperative Hospital LOS (d) | 14.0 [11.0; 22.0] | 22.0 [16.0; 35.0] | <0.001 ** |
Postoperative mechanical ventilation (h) | 5.0 [4.0; 8.0] | 16.0 [6.0; 80.0] | <0.001 ** |
Postoperative ICU LOS (d) | 44.0 [24.0; 86.0] | 109.0 [46.0; 165.0] | <0.001 ** |
Postoperative mortality (%) | 0 (0.0%) | 6 (4.9%) | 0.029 * |
Postoperative all-cause infection (%) | 6 (4.5%) | 17 (13.9%) | 0.015 * |
Postoperative reintubation (%) | 2 (1.5%) | 20 (16.4%) | <0.001 ** |
Variables | Univariate Analyses | Multivariate Analyses | ||||
---|---|---|---|---|---|---|
Crude OR | 95% CI | p-Value | Adjusted OR | 95% CI | p-Value | |
Hospital LOS | 2.992 | 1.635–5.477 | <0.001 ** | 3.235 | 1.606–6.516 | 0.001 ** |
Mechanical ventilation | 7.56 | 3.494–16.355 | <0.001 ** | 2.879 | 1.143–7.253 | 0.025 * |
ICU LOS | 7.149 | 3.641–14.039 | <0.001 ** | 4.911 | 2.223–10.849 | <0.001 ** |
Reintubation | 12.941 | 2.957–56.642 | 0.001 ** | 11.317 | 2.339–54.758 | 0.003 ** |
All-cause infection | 3.454 | 1.315–9.078 | 0.012 * | 2.393 | 0.789–7.255 | 0.123 |
AUC | Cutoff Point | Sensitivity | Specificity | 95% CI | Z Statistic | p-Value | ||
---|---|---|---|---|---|---|---|---|
Mechanical ventilation | 0.791 | 76 | 78.85 | 72.06 | 0.736–0.839 | 7.667 | <0.0001 | 1.606–6.516 |
ICU LOS | 0.773 | 76 | 75.76 | 74.74 | 0.717–0.823 | 7.476 | <0.0001 | 1.143–7.253 |
Hospital LOS | 0.612 | 37 | 69.35 | 57.73 | 0.550–0.672 | 2.702 | 0.0069 | 2.223–10.849 |
Reintubation | 0.623 | 40 | 73.91 | 54.94 | 0.560–0.682 | 1.852 | 0.0641 | 2.339–54.758 |
All-cause infection | 0.736 | 40 | 90.91 | 56.41 | 0.678–0.789 | 4.174 | <0.0001 | 0.789–7.255 |
Mortality | 0.824 | 305 | 83.33 | 76 | 0.771–0.868 | 4.588 | <0.0001 |
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Chen, S.; Wang, H.; Luo, D.; Zhang, C. Postoperative Alanine Aminotransferase Levels Are Associated with Outcomes in Pediatric Patients Undergoing Total Cavopulmonary Connection. Children 2022, 9, 1410. https://doi.org/10.3390/children9091410
Chen S, Wang H, Luo D, Zhang C. Postoperative Alanine Aminotransferase Levels Are Associated with Outcomes in Pediatric Patients Undergoing Total Cavopulmonary Connection. Children. 2022; 9(9):1410. https://doi.org/10.3390/children9091410
Chicago/Turabian StyleChen, Siyao, Han Wang, Dandong Luo, and Chongjian Zhang. 2022. "Postoperative Alanine Aminotransferase Levels Are Associated with Outcomes in Pediatric Patients Undergoing Total Cavopulmonary Connection" Children 9, no. 9: 1410. https://doi.org/10.3390/children9091410