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Prediction model and scoring system for in-hospital mortality risk in infants with heart failure aged 1-36 months: A
Meng Wei1,2, Shuai Shang1,2, Huasheng Lv1,2
1Department of Cardiac Function, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, China.
Insights
This study identified key factors like low total protein, acidosis, and abnormal respiratory rates that predict mortality in hospitalized infant and toddler heart failure patients. Predictive models and scoring tables can guide clinical decisions for these high-risk children.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Biostatistics
Background:
- Infant and toddler heart failure presents a significant mortality risk during hospitalization.
- Limited factors are currently known to influence mortality in this vulnerable population.
- There is a critical need to identify predictors and develop tools for risk assessment.
Purpose of the Study:
- To explore factors influencing mortality in hospitalized infant and toddler heart failure patients.
- To establish predictive models for mortality risk.
- To develop a mortality scoring table for clinical application.
Main Methods:
- A retrospective study included 544 infant heart failure patients, randomly assigned to training (380) and validation (164) sets.
- Lasso regression identified 14 significant variables from 88 independent factors.
- Multivariate logistic regression and model calibration were used to assess predictive performance.
Main Results:
- Total protein < 65 g/L, pH < 7.35, and abnormal respiratory rates were identified as independent risk factors for mortality.
- The predictive models demonstrated good discrimination (C-index train: 0.721, test: 0.728) and calibration.
- A mortality scoring table stratified patients into low, moderate, and high-risk categories, with significantly increased odds of mortality in higher risk groups.
Conclusions:
- The developed predictive models and scoring tables effectively assess mortality risk in hospitalized infants and toddlers with heart failure (1-36 months).
- These tools offer valuable clinical guidance and reference for managing high-risk pediatric heart failure patients.
- Further validation and implementation in clinical practice are recommended.
Background:
Existing studies report very few factors influencing the mortality of infant and toddler heart failure patients during hospitalization. Due to its high mortality rate, it is an important health issue. Therefore, this study aims to explore the factors influencing infant and toddler heart failure patients during hospitalization, establish predictive models, and a mortality scoring table.
Methods:
The study ultimately included 544 cases of infant heart failure patients. They were randomly divided into a training set (380 cases) and a validation set (164 cases) in a ratio of 7:3. The training set was then further divided into the death group and the survival group for further analysis of indicators during hospitalization.
Results:
Using the Lasso regression method, this study selected the best 14 variables from 88 independent variables of infants and toddlers with heart failure. Multivariate Logistic regression results show that TP < 65 g/L (OR = 2.34), pH < 7.35 (OR = 2.79), and Respiratory rate (1-12 months: <30times/min and 13-36 months: <25times/min, OR = 2.34) are independent risk factors. The model evaluation results for the train and test sets of infant and toddler heart failure patients are as follows: C-index values for discrimination in the train and test sets are 0.721 and 0.728, respectively. Fit test calibration evaluations show P values of 0.9958 and 0.9998, both greater than 0.05, indicating good calibration. The AUC values for the train and test sets are 0.75 and 0.64, respectively, showing a good predictive effect of the model. The mortality scoring table divides patients in the train and test sets into low risk, moderate-risk, and high risk categories. Compared to the low risk group, the OR values for the occurrence of mortality in the Medium risk group and high risk group in the train set are 3.78 and 11.67, respectively; in the test set, the OR values for the moderate-risk group and high-risk group are 1.73 and 6.33, respectively.
Conclusion:
The predictive models and scoring tables established in this study have a good predictive role in assessing the risk of death in infant and toddler heart failure patients aged 1-36 months during hospitalization, providing clinical guidance and reference value.
