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Predictive analytics characterize cardiovascular function and outcomes following cardiac surgery
Chelsea E Miller1, Sherry L Kausch2, Michael C Spaeder3
1Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA.
Insights
Pediatric cardiac surgery patients with higher cardiovascular and respiratory instability risk scores (CoMET score) showed worse clinical outcomes. Early identification via CoMET scores may enable timely interventions to improve patient prognoses.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular surgery outcomes
- Machine learning in healthcare
Background:
- Previously developed supervised machine learning models provide risk scores (CoMET score) for cardiovascular and respiratory instability within 12 hours.
- The CoMET score characterizes the risk of clinical deterioration.
- This study assesses the relationship between CoMET scores and vasoactive-inotropic scores (VIS) in pediatric patients post-cardiac surgery.
Purpose of the Study:
- To evaluate the correlation between CoMET scores and VIS in pediatric patients after cardiac surgery.
- To determine the association between CoMET scores and short-term clinical outcomes in this patient population.
Main Methods:
- Retrospective cohort study including all patients in a pediatric cardiac intensive care unit over 18 months.
- Comparative analyses were conducted to examine relationships between CoMET scores, VIS, and postoperative outcomes.
Main Results:
- A total of 296 postoperative courses were analyzed.
- Both cardiovascular and respiratory CoMET scores within 48 hours post-surgery correlated with VIS (p < 0.001).
- Higher cardiorespiratory CoMET scores were linked to longer ICU stays, fewer ventilator-free days, and increased risks of necrotizing enterocolitis, cardiac arrest, and in-hospital mortality.
Conclusions:
- CoMET scores effectively correlate with VIS and predict adverse clinical outcomes in pediatric patients post-cardiac surgery.
- These risk scores can identify high-risk patients, facilitating earlier interventions.
- Implementing CoMET scores may lead to improved patient outcomes following cardiac surgery.
Background:
Using supervised machine learning, predictive models of cardiovascular and respiratory instability were previously created and display risk scores (CoMET score), characterizing the risk of clinical deterioration in the ensuing 12 h. We assessed the relationship of CoMET scores with vasoactive-inotropic scores (VIS) and short-term clinical outcomes in pediatric patients following cardiac surgery.
Methods:
Retrospective cohort study of all patients admitted to the pediatric cardiac intensive care unit following cardiac surgery at a single center over an 18-month period. We performed comparative analyses to assess the relationships between CoMET scores and both VIS and postoperative clinical outcomes.
Results:
There were 296 postoperative courses in 262 patients during the period of study. Both cardiovascular and respiratory CoMET scores during the first 48 postoperative hours were correlated with VIS (p < 0.001). Increased cardiorespiratory CoMET scores during the first 48 postoperative hours were associated with longer postoperative cardiac intensive care unit length of stay (p = 0.004), decreased ventilator-free days (p < 0.001), and increased incidence of necrotizing enterocolitis (p = 0.039), cardiac arrest (p = 0.19), and in-hospital mortality (p = 0.003).
Conclusions:
Display of risk scores of cardiovascular and respiratory instabilities following cardiac surgery may help identify patients at risk for worse clinical outcomes, allowing for earlier intervention, potentially improving outcomes.
Impact:
Using previously established predictive models of risk of cardiovascular and respiratory instability, risk scores were correlated with vasoactive-inotropic scores in pediatric patients immediately following cardiac surgery. Increased risk scores following cardiac surgery were associated with increased intensive care unit length of stay, decreased ventilator-free days, and increased incidence of necrotizing enterocolitis, cardiac arrest, and in-hospital mortality. Display of risk scores of cardiovascular and respiratory instability following cardiac surgery may help identify patients at risk for worse clinical outcomes, allowing for earlier intervention, potentially improving outcomes.
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