Preoperative lymphopenia is a predictor of postoperative adverse outcomes in children with congenital heart disease

Cabrera, Antonio G.; Dyamenahalli, Umesh; Gossett, Jeffrey; Prodhan, Parthak; Morrow, W. Robert; Imamura, Michiaki; Jaquiss, Robert D.B.; Bhutta, Adnan T.

doi:10.1016/j.jtcvs.2009.06.016

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 5 , Pages 1172-1179, November 2009

Preoperative lymphopenia is a predictor of postoperative adverse outcomes in children with congenital heart disease

Antonio G. Cabrera, MD
- Department of Pediatrics, University of Tennessee, Memphis/Le Bonheur Children's Medical Center, Memphis, Tenn
Umesh Dyamenahalli, MD
- Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Ark
Jeffrey Gossett, MS
- Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Ark
Parthak Prodhan, MBBS
- Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Ark
W. Robert Morrow, MD
- Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Ark
Michiaki Imamura, MD, PhD
- Department of Surgery, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Ark
Robert D.B. Jaquiss, MD
- Department of Surgery, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Ark
Adnan T. Bhutta, MBBS
- Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Ark
- Address for reprints: Adnan T. Bhutta, MBBS, FAAP, Assistant Professor, University of Arkansas for Medical Sciences, 1 Children's Way, Slot 512, Little Rock, AR 72202.

Received 25 November 2008; received in revised form 3 April 2009; accepted 14 June 2009. published online 30 July 2009.

Objective

Lymphopenia is a predictor of adverse clinical outcomes in adults with various systemic diseases. We hypothesized that preoperative absolute lymphopenia (absolute lymphocyte count of less than 3000 cells/μL) is associated with adverse postoperative outcomes in children with congenital heart disease undergoing corrective or palliative surgery on cardiopulmonary bypass during the first 2 years of life.

Methods

A retrospective single center cohort study was performed. Categorical variables were analyzed with the χ² test. Preoperative variables were analyzed with logistic and linear regression analysis to determine whether they were associated with adverse outcomes.

Results

Analysis was performed on 280 patients, of whom 124 were female and 156 were male. Seventy-one patients were neonates (≤30 days) at the time of the operation. Ninety patients had an absolute lymphocyte count of less than 3000 cells/μL before the operation. Regression models showed that RACHS-1 categories 5 and 6, age, and preoperative lymphopenia were significantly associated with postoperative mortality (P < .0006). Within RACHS-1 groups, lymphopenia remained a significant predictor of mortality for patients in RACHS categories 3 and 4. Lymphopenia and age were associated with longer length of stay and length of mechanical ventilation within RACHS categories 1 to 4 (P < .05). Preoperative lymphopenia was the only predictor of use of postoperative nitric oxide (P < .05).

Conclusions

Preoperative lymphopenia is a predictor of adverse postoperative outcomes in children with congenital heart disease who undergo a corrective or palliative procedure with cardiopulmonary bypass during the first 2 years of life.

CTSNet classification: 20, 21

Abbreviations and Acronyms: ALC, absolute lymphocyte count, CI, confidence interval, OR, odds ratio, RACHS-1, Risk Adjusted classification for Congenital Heart Surgery, ROC, receiver operating characteristic