title: Retuning mortality risk prediction in paediatric cardiac surgery: the additional role of early postoperative metabolic and respiratory profile.
abstract: OBJECTIVE
  The existing risk stratification scores for paediatric patients undergoing cardiac surgery include the Aristotle Basic Complexity (ABC) Score, the Risk Adjustment in Congenital Heart Surgery-1 (RACHS-1) Score and the Aristotle Comprehensive Complexity (ACC) Score. They are all based on the nature of the surgical operation (ABC and RACHS-1 Scores) with possible adjustment for a number of patient conditions (ACC Score). The present study investigates if the early postoperative parameters may be used to improve the preoperative mortality risk prediction.
  
  
  METHODS
  A retrospective study on 1392 consecutive patients aged ≤12 years old, undergoing cardiac surgery with cardiopulmonary bypass and without a residual right-to-left shunt was conducted. The ABC Score and metabolic and respiratory postoperative parameters at arrival in the intensive care unit were tested for association and discriminative power for operative mortality.
  
  
  RESULTS
  The ABC yielded a c-statistic of 0.746. Additional independent predictors of operative mortality were postoperative hypoxia [Formula: see text] and arterial blood lactates. In a multivariable model including the ABC Score, postoperative hypoxia and arterial blood lactates remained independently associated with operative mortality. A modified ABC Score was created, consisting of the ABC Score plus 1.5 points in case of postoperative hypoxia plus 1 point per each 1 mmol/l of arterial blood lactates. The new model was significantly (P = 0.043) more discriminative than the ABC Score, with a c-statistic of 0.803.
  
  
  CONCLUSIONS
  Early postoperative respiratory and metabolic parameters increased the accuracy and discrimination of the ABC Score. An external validation is needed to confirm our results.
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy cardioanestesia@virgilio.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Ranucci
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Pistuddi
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Giulia Pinuccia
authors.initials: GP
authors.lastname: Pisani
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Concetta
authors.initials: C
authors.lastname: Carlucci
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Isgrò
authors.affiliation: Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Frigiola
authors.affiliation: Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pomè
authors.affiliation: Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giamberti
mesh_terms: D006348:Cardiac Surgical Procedures / Q000401:mortality*; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D007223:Infant; D007773:Lactates / Q000097:blood; D008297:Male; D015233:Models, Statistical; D011184:Postoperative Period; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
chemical_list: D007773:Lactates
keywords: Congenital heart surgery; Operative mortality; Risk stratification