Aims

To determine the prevalence of pulmonary hypertension (PH) among children with in-hospital cardiac arrest (IHCA) and its association with survival.

Methods

Children (<18 years) admitted to ICUs participating in the Virtual Pediatric Systems multicenter registry between January 2011 and December 2017 who had an IHCA during their hospitalization were included. Patients were classified by whether they had a documented diagnosis of PH at the time of IHCA. Clinical characteristics were compared between patients with and without PH. After propensity score matching, conditional logistic regression within the matched cohort determined the association between PH and survival to hospital discharge.

Results

Of 18,575 children with IHCA during the study period, 1,590 (8.6%) had a pre-arrest diagnosis of PH. Patients with PH were more likely to be 29 days to 2 years of age, female, Black/African American, and American Indian/Alaskan Native, and to be treated in a cardiac ICU or mixed PICU/cardiac ICU. At ICU admission, PH patients had a lower probability of death as determined by the Pediatric Index of Mortality 2 (PIM-2) score. Patients with PH were more likely to be receiving inhaled nitric oxide (13.0% vs. 2.1%; p < 0.001). Propensity score matching successfully matched 1,302 PH patients with 3,604 non-PH patients. Patients with PH were less likely to survive to hospital discharge (aOR 0.83; 95% CI: 0.72–0.95; p = 0.01) than non-PH patients.

Conclusions

In this large multicenter study, 8.6% of children with IHCA had pre-existing documented PH. These children were less likely to survive to hospital discharge than those without PH.

中文翻译：

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院内心脏骤停儿童的肺动脉高压：一项多中心研究

目标

确定院内心脏骤停 (IHCA) 儿童中肺动脉高压 (PH) 的患病率及其与生存率的关系。

方法

纳入了 2011 年 1 月至 2017 年 12 月期间参与虚拟儿科系统多中心登记的 ICU 中住院期间患有 IHCA 的儿童（<18 岁）。患者根据在 IHCA 时是否有记录的 PH 诊断进行分类。比较有和没有 PH 的患者的临床特征。在倾向得分匹配后，匹配队列中的条件逻辑回归确定了 PH 与出院生存率之间的关联。

结果

在研究期间，18,575 名 IHCA 儿童中，1,590 名 (8.6%) 被逮捕前诊断为 PH。PH 患者更可能为 29 天至 2 岁、女性、黑人/非洲裔美国人和美洲印第安人/阿拉斯加原住民，并在心脏 ICU 或混合 PICU/心脏 ICU 接受治疗。根据儿科死亡率指数 2 (PIM-2) 评分，在 ICU 入院时，PH 患者的死亡概率较低。PH 患者更可能接受吸入一氧化氮（13.0% 对 2.1%；p < 0.001）。倾向评分匹配成功地将 1,302 名 PH 患者与 3,604 名非 PH 患者匹配。与非 PH 患者相比，PH 患者存活出院的可能性更低（aOR 0.83；95% CI：0.72-0.95；p = 0.01）。

结论

在这项大型多中心研究中，8.6% 的 IHCA 儿童有既往记录的 PH。与没有 PH 的儿童相比，这些儿童存活出院的可能性更小。