Sepsis After Cardiac Surgery Early in Infancy and Adverse 4.5‐Year Neurocognitive Outcomes

Abstract

BackgroundWe aimed to determine whether sepsis is associated with neurocognitive outcomes 4.5 years after congenital heart disease surgery in early infancy.Methods and ResultsA secondary analysis from a prospective inception cohort included all children having congenital heart disease surgery done at ≤6 weeks of age with cardiopulmonary bypass at the Western Canadian referral center from 1996 to 2009. Follow-up at the referral center determined the primary outcomes at 4.5 years with full-scale, performance, and verbal intelligence quotients on the Wechsler Preschool and Primary Scale of Intelligence. Perioperative variables were collected prospectively, and confirmation of blood culture–positive sepsis was done retrospectively. Multiple linear regression models for neurocognitive outcomes and multiple Cox proportional hazards regression for mortality were determined. Sepsis occurred in 97 of 502 patients (19%) overall and in 76 of 396 survivors (19%) with 4.5-year follow-up. By 4.5 years, there were 91 (18%) deaths, and 396 of 411 survivors (96%) had follow-up completed. Extracorporeal membrane oxygenation was associated with worse scores on all neurocognitive outcomes on multivariable regression; the association between extracorporeal membrane oxygenation and full-scale intelligence quotient had a regression coefficient of −13.6 (95% CI −21.3 to −5.9; P =0.001). Sepsis perioperatively was associated with performance and verbal intelligence quotients, with a trend for full-scale intelligence quotient (P =0.058) on multivariable regression. The regression coefficient for sepsis was strongest for performance intelligence quotient (−5.31; 95% CI −9.84 to −0.78; P =0.022). Sepsis was not but extracorporeal membrane oxygenation was associated with mortality by 4.5 years.ConclusionsPerioperative sepsis and extracorporeal membrane oxygenation were associated with adverse neurocognitive outcomes on multivariable regression. Quality improvement to prevent sepsis has the potential to improve long-term neurocognitive outcomes in infants after surgery for congenital heart disease.

Developmental outcomes after early surgery for complex congenital heart disease: a systematic review and meta‐analysis

“…Figure 2a depicts a forest plot of papers included in the meta-analysis for full-scale IQ scores. 62,71,81,88,[92][93][94]99,100,[107][108][109] Fourteen papers generated 22 entries that could be included in this meta-analysis. Some papers generated more than one outcome: Creighton et al 81 and Ryberg et al 109 each compared outcomes of four groups of children with different CHD in two different studies; Sterken et al 99 compared outcomes of children with complex CHD and typically developing groups at two different periods; and Sarajuuri et al 92 compared two groups of children with single-ventricle defects and typically developing groups.…”

Comparison of pediatric scoring systems for mortality in septic patients and the impact of missing information on their predictive power: a retrospective analysis

“…In septic patients there is a similar problem: in some cases sepsis was the reason for admission, while in other cases sepsis developed during the course of hospital stay, possibly in postoperative patients (Sidhu et al, 2015;Wang et al, 2018). In such a case, sepsis cannot be predicted at the time of admission and thus at the time of data collection.…”

“…For each score, the development identified specific times or timescales for patient enrollment, within which the score provides the most accurate indication of the patient's condition and the likelihood of survival (Leteurtre et al, 2006;Leteurtre et al, 2013;Leteurtre et al, 1999;Pollack et al, 2016;Pollack, Patel & Ruttimann, 1996b;Pollack, Ruttimann & Getson, 1988;Shann et al, 1997;Slater, Shann & Pearson, 2003;Straney et al, 2013). However, some patients develop certain life-threatening conditions-such as sepsis-only during their inpatient stay and are actually hospitalized for a completely different reason, for example following a surgical intervention (Sidhu et al, 2015). In such a case, it is obvious that the condition of the patient determined at admission can only conditionally predict the course of a complication developed at a later time.…”

Peer Review #1 of "Comparison of pediatric scoring systems for mortality in septic patients and the impact of missing information on their predictive power: a retrospective analysis (v0.1)"

“…In septic patients there is a similar problem: in some cases sepsis was the reason for admission, while in other cases sepsis developed during the course of hospital stay, possibly in postoperative patients (Sidhu et al 2015;Wang et al 2018). In such a case, sepsis cannot be predicted at the time of admission and thus at the time of data collection.…”

“…For each score, the development identified specific times or timescales for patient enrollment, within which the score provides the most accurate indication of the patient's condition and the likelihood of survival (Leteurtre et al 2006;Leteurtre et al 2013;Leteurtre et al 1999;Pollack et al 2016;Pollack et al 1996b;Pollack et al 1988;Shann et al 1997;Slater et al 2003;Straney et al 2013). However, some patients develop certain life-threatening conditions -such as sepsisonly during their inpatient stay and are actually hospitalized for a completely different reason, for example following a surgical intervention (Sidhu et al 2015). In such a case, it is obvious that the condition of the patient determined at admission can only conditionally predict the course of a complication developed at a later time.…”