Preoperative Vitamin D Deficiency Is Associated With Higher Vasoactive-Inotropic Scores Following Pediatric Cardiac Surgery in Chinese Children

Xiuxia Ye; Shumei Dong; Yujiao Deng; Chuan Jiang; Yanting Kong; Lili Tang; Yanlin Wang; Fei Bei; Haifa Hong

doi:10.3389/fped.2021.671289

Preoperative Vitamin D Deficiency Is Associated With Higher Vasoactive-Inotropic Scores Following Pediatric Cardiac Surgery in Chinese Children

Front Pediatr. 2021 Jul 28:9:671289. doi: 10.3389/fped.2021.671289. eCollection 2021.

Authors

Xiuxia Ye^{1

2}, Shumei Dong¹, Yujiao Deng¹, Chuan Jiang³, Yanting Kong¹, Lili Tang¹, Yanlin Wang⁴, Fei Bei¹, Haifa Hong³

Affiliations

¹ Department of Neonatal Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, and National Children's Medical Center, Shanghai, China.
² Child Health Advocacy Institute, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China.
³ Shanghai Institute for Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, and National Children's Medical Center, Shanghai, China.
⁴ Perinatal Medicine Department of International Peace Maternal and Child Health Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.

Abstract

The relationship between vitamin D and cardiovascular health in children remains unclear. Vitamin D deficiency (VDD) is supposed to be a potential risk factor associated with poorer outcomes after congenital heart disease (CHD) surgery. The maximum vasoactive-inotropic use after cardiac surgery is considered to be a good predictor of adverse outcomes. We aimed to assess the correlation between preoperative VDD and the maximum vasoactive-inotropic score (VIS_max) at 24 h postoperatively. Nine hundred children with CHD were enrolled in this study, and preoperative total serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured by liquid chromatography-tandem mass spectrometry. Related demographic and clinical characteristics were collected. A total of 490 boys (54.4%) and 410 girls (45.6%) with a mean age of 1 year (range: 6 months-3 years) were enrolled. The median 25(OH)D level was 24.0 ng/mL, with 32.6% of patients having VDD [25(OH)D < 20 ng/mL]. The univariate analysis indicated that VDD [odds ratio (OR): 2.27; 95% confidence interval (CI): 1.48-3.50] is associated with a risk of increased VISmax at 24 h postoperation. Multivariate analysis revealed that VDD (OR: 1.85; 95% CI: 1.09-3.02), a Risk-adjusted Congenital Heart Surgery score of at least three points (OR: 1.55; 95% CI: 1.09-2.19), and cardiopulmonary bypass time (OR: 1.02; 95% CI: 1.01-1.02) were independently associated with an increased VISmax within 24 h after cardiac surgery. VDD in pediatric patients before cardiac surgery is associated with the need for increased postoperative inotropic support at 24 h postoperation.

Keywords: cardiac surgery; children; congenital heart disease; vasoactive inotropic score; vitamin D deficiency.