Prognostic Value of Preoperative Absolute Lymphocyte Count in Children With Tetralogy of Fallot.
Prognostic Value of Preoperative Absolute Lymphocyte Count in Children With Tetralogy of Fallot.
复制标题
法洛四联症患儿术前绝对淋巴细胞计数的预后价值
DOI：
10.1161/jaha.120.019098
复制
发表时间：
2021-06
影响因子：
5.4
通讯作者：
Yan F
中科院分区：
文献类型：
--
作者：
Wu X;Luo Q;Su Z;Li Y;Wang H;Yuan S;Yan F
法洛四联症（TOF）是最常见的青紫型先天性心脏病。绝对淋巴细胞计数（ALC）是一种低成本且易于获得的炎症指标；然而，其与TOF患者预后的关系尚不清楚。本研究旨在确定术前ALC对TOF患儿预后的价值。本回顾性研究纳入了2016年1月至2018年12月在中国阜外医院接受TOF矫正手术的707例年龄<6岁的患者。终点为死亡率、体外膜充氧、术后住院时间bbb30天、严重并发症；根据预后分为预后差（76例）和预后好（631例）。通过单变量和多变量logistic回归分析，确定预后不良的独立危险因素，并以此为基础建立风险评分系统。采用受试者工作特征曲线评价模型性能。采用另一种不含ALC的模型，评估添加ALC的效果。结果提示ALC是一个独立的因素，临界值为4.36×109/L。ALC的加入使曲线下面积由0.771提高到0.781 （P<0.001）。为避免反向因果关系，进一步控制混杂因素，根据ALC水平对患者进行进一步分组，并进行倾向评分匹配；117名配对患者被确定用于进一步分析。低ALC水平的优势比为3.500 （95% CI, 1.413-8.672）。术前低ALC是TOF患儿预后不良的独立预测因子。
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Absolute lymphocyte count (ALC) is a low‐cost and easy‐to‐obtain inflammatory indicator; however, its association with the prognosis of patients with TOF remains unknown. This study aimed to determine the prognostic value of preoperative ALC in children with TOF. This retrospective study included 707 patients aged <6 years who underwent corrective operations for TOF between January 2016 and December 2018 in Fuwai Hospital, China. The end points were mortality, extracorporeal membrane oxygenation placement, postoperative hospital stay >30 days, and severe postoperative complications; patients were grouped on the basis of prognosis: poor prognosis (n=76) and good prognosis (n=631). Univariable and multivariable logistic regression analyses were performed to identify the independent risk factors for poor prognosis, on which a risk scoring system was based. The receiver operating characteristic curve was used to assess model performance. Using another model without ALC, the effect of the addition of ALC was assessed. Results suggested that ALC was an independent factor with a cutoff point of 4.36×109/L. The addition of ALC improved the area under the curve from 0.771 to 0.781 (P<0.001). To avoid reverse causality and further control for confounding factors, the patients were further divided on the basis of ALC level, and a propensity score matching was performed; 117 paired patients were identified for further analysis. Low ALC levels had an odds ratio of 3.500 (95% CI, 1.413–8.672). Low preoperative ALC represents an independent predictor of poor prognosis in children with TOF.