Risk Factors for Adverse Outcomes in a Fontan Population.

IF 1.4 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Giancarlo Licitra, Lindsey C Ivey, Cheryl L Raskind-Hood, Fred H Rodriguez, Yuting Guo, Abeed Sarker, Wendy M Book
{"title":"Risk Factors for Adverse Outcomes in a Fontan Population.","authors":"Giancarlo Licitra, Lindsey C Ivey, Cheryl L Raskind-Hood, Fred H Rodriguez, Yuting Guo, Abeed Sarker, Wendy M Book","doi":"10.1007/s00246-025-03902-9","DOIUrl":null,"url":null,"abstract":"<p><p>Improved survival following Fontan surgery is tempered by late Fontan failure. Heterogeneous multi-organ complications contribute to eventual Fontan failure varying over time. The prevalence of Fontan-related complications and their association with adverse outcomes were evaluated. A Fontan cohort of 668 pediatric (n = 490) and adult (n = 178) patients from two healthcare systems were linked to 2010-2019 healthcare encounters and death certificates. Bivariate analyses examined covariates by the primary composite outcome of heart transplant, hepatocellular carcinoma (HCC) or death. Multivariate logistic regression explored associations of risk factors with the primary composite outcome and a secondary outcome of hospitalization. Kaplan-Meier curves compared freedom from the primary composite outcome stratified by number of concurrent risk factors at initial encounter. Of 668 Fontan patients, 12.3% developed the primary composite outcome (21.3% adults, 9.0% children). Clinical risk factors increased with age and time, and were significantly associated with HCC, a component of the primary outcome. Patients with 3 + risk factors had significantly worse survival (log-rank p < 0.01). Heart failure (HF) was the strongest independent predictor of outcomes (aOR 5.90, p < 0.01). Dysrhythmia, cyanosis, and HF were associated with more hospitalizations. The primary composite outcome was 4-fold higher with 3 + risk factors (aOR 3.71, 95% CI 2.26-6.16), significant in children (aOR 3.01, 95% CI 1.17-7.0), and adults (aOR 2.58, 95% CI 1.04-7.48). Complications increase as Fontan patients age and are associated with transplant, HCC, death, and hospitalizations in a pediatric and adult cohort. Early identification and intervention for Fontan-related complications may improve late outcomes.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.4000,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00246-025-03902-9","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

Abstract

Improved survival following Fontan surgery is tempered by late Fontan failure. Heterogeneous multi-organ complications contribute to eventual Fontan failure varying over time. The prevalence of Fontan-related complications and their association with adverse outcomes were evaluated. A Fontan cohort of 668 pediatric (n = 490) and adult (n = 178) patients from two healthcare systems were linked to 2010-2019 healthcare encounters and death certificates. Bivariate analyses examined covariates by the primary composite outcome of heart transplant, hepatocellular carcinoma (HCC) or death. Multivariate logistic regression explored associations of risk factors with the primary composite outcome and a secondary outcome of hospitalization. Kaplan-Meier curves compared freedom from the primary composite outcome stratified by number of concurrent risk factors at initial encounter. Of 668 Fontan patients, 12.3% developed the primary composite outcome (21.3% adults, 9.0% children). Clinical risk factors increased with age and time, and were significantly associated with HCC, a component of the primary outcome. Patients with 3 + risk factors had significantly worse survival (log-rank p < 0.01). Heart failure (HF) was the strongest independent predictor of outcomes (aOR 5.90, p < 0.01). Dysrhythmia, cyanosis, and HF were associated with more hospitalizations. The primary composite outcome was 4-fold higher with 3 + risk factors (aOR 3.71, 95% CI 2.26-6.16), significant in children (aOR 3.01, 95% CI 1.17-7.0), and adults (aOR 2.58, 95% CI 1.04-7.48). Complications increase as Fontan patients age and are associated with transplant, HCC, death, and hospitalizations in a pediatric and adult cohort. Early identification and intervention for Fontan-related complications may improve late outcomes.

Fontan人群不良结果的危险因素。
Fontan手术后生存率的提高因晚期Fontan失败而受到影响。随着时间的推移,不同的多器官并发症导致最终的丰坦衰竭。评估丰坦相关并发症的发生率及其与不良结局的关系。来自两个医疗保健系统的668名儿童(n = 490)和成人(n = 178)患者的Fontan队列与2010-2019年的医疗保健就诊和死亡证明相关联。双变量分析通过心脏移植、肝细胞癌(HCC)或死亡等主要复合结局检查协变量。多因素logistic回归探讨了危险因素与主要综合结局和住院治疗的次要结局的关系。Kaplan-Meier曲线比较了初始相遇时并发危险因素数量分层的主要复合结局的自由度。在668例Fontan患者中,12.3%的患者出现了主要的复合结局(成人21.3%,儿童9.0%)。临床危险因素随着年龄和时间的增加而增加,并且与HCC显著相关,HCC是主要结局的一个组成部分。有3个以上危险因素的患者生存率明显较差(log-rank p
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Pediatric Cardiology
Pediatric Cardiology 医学-小儿科
CiteScore
3.30
自引率
6.20%
发文量
258
审稿时长
12 months
期刊介绍: The editor of Pediatric Cardiology welcomes original manuscripts concerning all aspects of heart disease in infants, children, and adolescents, including embryology and anatomy, physiology and pharmacology, biochemistry, pathology, genetics, radiology, clinical aspects, investigative cardiology, electrophysiology and echocardiography, and cardiac surgery. Articles which may include original articles, review articles, letters to the editor etc., must be written in English and must be submitted solely to Pediatric Cardiology.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信