(14 - Saturday) Pediatric Sequential Organ Failure Score Helps Predict End Organ Dysfunction in Congenital Heart Disease Patients After Cardiopulmonary Bypass

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Abstract:

Introduction: Patients with complex congenital heart disease (CHD) who have undergone cardiopulmonary bypass (CPB) for surgical repair or palliation are at risk of developing end organ dysfunction (EOD) post-operatively and go on to develop low cardiac output syndrome (LCOS), require initiating extracorporeal membrane oxygenation (ECMO), require renal replacement therapy (CRRT), develop strokes or die. Early recognition and preemptive treatment of EOD is imperative to improving survival in the post-cardiotomy period but remains difficult given physiological complexity of the post-bypass state. The pediatric sequential organ failure score (pSOFA) is an easily measurable organ dysfunction score adapted from an adult sepsis score, consisting of respiratory, cardiovascular, GI, renal and neurological biomarkers. However, its use in the CHD population has not been well studied.

The purpose of this study is to create a model to predict which patients with complex CHD develop EOD after CPB for reparative or palliative cardiac surgery. We hypothesize that the pSOFA score will allow for accurate and early prediction of EOD after taking preoperative, intraoperative, and postoperative data into account using our model.

Methods: We conducted a single center retrospective cohort study utilizing data from our electronic medical record, the Society of Thoracic Surgeons (STS) and Pediatric Cardiac Critical Care Consortium (PC4) databases for children. We included neonates and children (0 days to < 20 years of age) who received cardiopulmonary bypass for reparative or palliative cardiac surgery at Children’s Medical Center in Dallas Texas between 2019-2021 (n=94). Preoperative (demographics, diagnosis, baseline creatinine, risk factors etc.) intraoperative (STAT category/score, operation, cardiopulmonary bypass time, etc.) and postoperative (pSOFA, minute-to-minute vital sign data, lab markers) variables were included. Patients with missing data were excluded. The analysis was carried out using STATA/MP 17 using the logistic procedure.

Results: The number of reported preoperative risk factors were positively associated with the likelihood of developing EOD. Among intraoperative risk factors, bypass time (min) and usage of blood products were associated with developing EOD. The average pSOFA score was found to be positively and significantly associated with the development of EOD. (Please see Table 1.)

Conclusion: Our study was able to identify several key variables associated with the development of EOD in neonatal and pediatric patients undergoing CPB for CHD surgery, and also identified that the pSOFA score is positively associated with the development of EOD. We were also able to create a prediction model for the development of EOD using logistic regression. Future directions for our study will involve using artificial intelligence (AI) to create a similar model and compare between traditional statistics and AI.