title: Exploring the Role of Polycythemia in Patients With Cyanosis After Palliative Congenital Heart Surgery.
abstract: OBJECTIVE
  To understand the relationship between polycythemia and clinical outcome in patients with hypoplastic left heart syndrome following the Norwood operation.
  
  
  METHODS
  A retrospective, single-center cohort study.
  
  
  METHODS
  Pediatric cardiovascular ICU, university-affiliated children's hospital.
  
  
  METHODS
  Infants with hypoplastic left heart syndrome admitted to our medical center from September 2009 to December 2012 undergoing stage 1/Norwood operation.
  
  
  METHODS
  None.
  
  
  RESULTS
  Baseline demographic and clinical information including first recorded postoperative hematocrit and subsequent mean, median, and nadir hematocrits during the first 72 hours postoperatively were recorded. The primary outcomes were in-hospital mortality and length of hospitalization. Thirty-two patients were included in the analysis. Patients did not differ by operative factors (cardiopulmonary bypass time and cross-clamp time) or traditional markers of severity of illness (vasoactive inotrope score, lactate, saturation, and PaO2/FIO2 ratio). Early polycythemia (hematocrit value > 49%) was associated with longer cardiovascular ICU stay (51.0 [± 38.6] vs 21.4 [± 16.2] d; p < 0.01) and total hospital length of stay (65.0 [± 46.5] vs 36.1 [± 20.0] d; p = 0.03). In a multivariable analysis, polycythemia remained independently associated with the length of hospitalization after controlling for the amount of RBC transfusion (weight, 4.36 [95% CI, 1.35-7.37]; p < 0.01). No difference in in-hospital mortality rates was detected between the two groups (17.6% vs 20%).
  
  
  CONCLUSIONS
  Early polycythemia following the Norwood operation is associated with longer length of hospitalization even after controlling for blood cell transfusion practices. We hypothesize that polycythemia may be caused by hemoconcentration and used as an early marker of capillary leak syndrome.
authors.affiliation: 1Department of Pediatrics, Stanford Children's Health, Stanford University, Palo Alto, CA. 2Department of Surgery, Stanford University, Palo Alto, CA. 3Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Siehr
authors.forename: Shenghui
authors.initials: S
authors.lastname: Shi
authors.forename: Shiying
authors.initials: S
authors.lastname: Hao
authors.forename: Zhongkai
authors.initials: Z
authors.lastname: Hu
authors.forename: Bo
authors.initials: B
authors.lastname: Jin
authors.forename: Frank
authors.initials: F
authors.lastname: Hanley
authors.forename: Vadiyala Mohan
authors.initials: VM
authors.lastname: Reddy
authors.forename: Doff B
authors.initials: DB
authors.lastname: McElhinney
authors.forename: Xuefeng Bruce
authors.initials: XB
authors.lastname: Ling
authors.forename: Andrew Y
authors.initials: AY
authors.lastname: Shin
mesh_terms: D003490:Cyanosis / Q000209:etiology; D005260:Female; D006400:Hematocrit / Q000145:classification; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000150:complications / Q000601:surgery*; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D058327:Norwood Procedures; D010166:Palliative Care; D011086:Polycythemia / Q000175:diagnosis / Q000209:etiology*; D011183:Postoperative Complications; D012189:Retrospective Studies