title: Systemic inflammatory response syndrome after pediatric congenital heart surgery: Incidence, risk factors, and clinical outcome.
abstract: BACKGROUND
  Systemic inflammatory response syndrome (SIRS) is frequent after cardiac surgery, but data on its incidence and perioperative risk factors are scarce for children with congenital heart disease.
  
  
  METHODS
  SIRS incidence within 72 hours following cardiac surgery was evaluated in a secondary analysis of children enrolled to a treatment-free control group of a randomized controlled trial. Intraoperative parameters were investigated for their association with SIRS using multivariable fractional polynomial logistic regression models. Effects of SIRS on various organ functions and length of stay were evaluated using time-varying Cox regression models.
  
  
  RESULTS
  In 116 children after cardiac surgery (median age [range]: 7.4 month [1 day-16.2 years]) SIRS occurred in n = 39/102 with and n = 1/14 without cardiopulmonary bypass (CPB). Duration of CPB (hazard ratio [HR]: 2.28 per hour; 95% confidence interval [CI] 1.17; 4.42) and amount of fresh frozen plasma (HR: 1.23 per 10 mL/kg; 95%CI 1.06; 1.42) were identified as predictors for SIRS; neonates seemed to be less susceptible for SIRS development (HR: 0.86; 95%CI 0.79; 0.95). SIRS was associated with organ dysfunction (HR: 2.69; 95%CI 1.41; 5.12) and extended stay in the pediatric intensive care unit (PICU) (median: 168 vs. 96 hours; p = 0.007).
  
  
  CONCLUSIONS
  SIRS is a frequent complication after pediatric congenital heart surgery; it affects nearly one third of children and prolongs PICU stay significantly. Duration of CPB and amount of fresh frozen plasma were identified as important risk factors. Neonates seem to be less susceptible to SIRS development.
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Boehne
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Sasse
authors.affiliation: Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany.
authors.forename: André
authors.initials: A
authors.lastname: Karch
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Friederike
authors.initials: F
authors.lastname: Dziuba
authors.affiliation: Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Horke
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Kaussen
authors.affiliation: Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany.
authors.forename: Rafael
authors.initials: R
authors.lastname: Mikolajczyk
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Beerbaum
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Jack
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology* / Q000209:etiology