Abstract 13984: Do Immunologic Differences Contribute to Racial and Ethnic Disparities Following Congenital Heart Surgery?
Background: Lymphopenia, thrombocytopenia, and neutrophilia are associated with adverse outcomes in adults with heart disease but have not been well studied in children. Similarly, immunologic factors have been shown to contribute to racial differences in outcomes in children following heart transplant, but have not been studied for other heart surgeries. We aimed to determine a) the association of these preoperative immunologic markers with in-hospital mortality following congenital heart surgery (CHS) in children and b) whether these markers differed by race/ethnicity.
Methods: We performed a retrospective cohort study of 4057 children (≤21yo) undergoing CHS at our institution in 2004-2010. Using chi-square tests and multiple logistic regression, we analyzed the association of baseline preoperative lymphopenia (lymphocyte count ≤3000 cells/μL), thrombocytopenia (platelet count <150x103 cells/μL), and neutroplillia (neutrophil count ≥7000 cells/μL) with in-hospital mortality while controlling for age, race/ethnicity, and RACHS-1 category (Risk Adjustment for Congenital Heart Surgery). Patients with inadequate lab data or a surgery which could not be categorized by RACHS-1 criteria were excluded.
Results: In our cohort of 3374 eligible patients, lymphopenia was associated with increased mortality (OR 1.8, 95% CI 1.3-2.4, p<0.001) and thrombocytopenia tended to be (OR 1.6, 95% CI 0.99-2.5, p=0.057). Neutrophilia was not (p=0.43). While both blacks and Hispanics had increased odds of mortality compared to whites (p=0.002 and <0.001, respectively), blacks tended to be more likely than whites to have lymphopenia (p=0.07) and thrombocytopenia (p=0.03), but Hispanics did not. (Table)
Conclusions: Preoperative lymphopenia and thrombocytopenia may be associated with increased mortality following CHS in children but neutrophilia is not. Immunologic differences may contribute to disparities in outcomes for blacks but not for Hispanics.
- © 2013 by American Heart Association, Inc.