Abstract 15355: Dysnatremia is Associated With Adverse Outcomes in Pediatric Patients After Surgery Under Cardiopulmonary Bypass for Congenital Heart Disease
Background: Sodium imbalances are one of the most common electrolyte disorders in ICU and have been associated with adverse outcomes in many patient groups. Few studies have investigated associations between dysnatremia and outcomes in children after surgery for congenital heart disease (CHD).
Methods: Retrospective chart review of children (01/12 to 01/15) after CHD surgery with cardiopulmonary bypass (CPB). Infants operated at < 37 weeks of gestation or > 18 years of age were excluded. Data collected: age, gender, weight, Risk Adjusted Congenital Heart Surgery Score (RACHS-1) classification; mechanical ventilation (MV), CPB and cross clamp (CC) times; serum sodium (Na) 24, 48 and 72 hrs after surgery; hospital length of stay (LOS), adverse neurological events (strokes or seizures) and mortality. Na level <135mmol/L was defined as hyponatremia and >145 mmol/L as hypernatremia. Comparisons between groups by logistic regression analysis.
Results: 1177 encounters (55.7% males) were included. Median (IQR) age 13.6 (3.4-67) months, weight 8.9 (4.9-18.6) kg. 180 (15.3%) patients were in RACHS-1 category 4-6. Hospital LOS 8 (5-15) days; MV time 23.5 (7.1-58) hours; CPB time 138 (92-192) min; CC time 77 (38-121) min. Post-operative dysnatremia was 46.3%; 16.14% had hyponatremia, 27.7% hypernatremia and 1.44% had both in the first 72 hours. Post-operative mortality (1.7%) was associated with hypernatremia at 24 hrs (Odds Ratio (OR) 4.9 [2.2-11], p=0.0001); 48 hrs (OR 4.8 [2.0-11], p=0.0003); 72 hrs (OR 5.3 [2.2-12.7], p=0.0002); no association between hyponatremia and mortality. In a univariate logistic regression analysis, hypernatremia, not hyponatremia, at all time points was significantly associated with adverse neurological event at 24 hrs(OR 3.9 [1.6-9.5], p=0.0028); 48 hrs (OR 3.3 [1.3-8.8], p=0.0163) and 72 hrs (OR 3.4 [1.3-9.3], p=0.0139). In a multivariable model controlling for age, LOS and CC times, prolonged CPB time was associated with post-operative hypernatremia (OR1.01 [1.00-1.01], p=0.0012).
Conclusions: Perioperative dysnatremia was a common finding in pediatric cardiac surgical patients. Hypernatremia was more prevalent than hyponatremia, and was associated with increased CPB time, adverse neurological outcome and mortality.
Author Disclosures: A. Ontaneda: None. J. Lasa: None. A. Akcan-Arikan: None. J. Coss-Bu: None. L. Shekerdemian: None.
- © 2016 by American Heart Association, Inc.