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Modelling survival and mortality risk to 15 years of age for a national cohort of children with serious congenital heart defects diagnosed in infancy

Knowles, Rachel L ; Bull, Catherine ; Wren, Christopher ; Wade, Angela ; Goldstein, Harvey ; Dezateux, Carol Ricci, Zaccaria

PloS one, 2014-09, Vol.9 (8), p.e106806-e106806 [Periódico revisado por pares]

United States: Public Library of Science

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Modelling survival and mortality risk to 15 years of age for a national cohort of children with serious congenital heart defects diagnosed in infancy
Autor: Knowles, Rachel L ; Bull, Catherine ; Wren, Christopher ; Wade, Angela ; Goldstein, Harvey ; Dezateux, Carol
Ricci, Zaccaria
Assuntos: Adolescent ; Adults ; Age ; Cardiology ; Cardiovascular disease ; Cause of Death ; Child ; Child Mortality - trends ; Child, Preschool ; Childbirth & labor ; Children ; Children & youth ; Childrens health ; Collaboration ; Complications ; Confidence intervals ; Congenital diseases ; Death ; Defects ; Diagnosis ; Ethics ; Female ; Gender ; Hazards ; Heart ; Heart Defects, Congenital - mortality ; Heart diseases ; Heart surgery ; Hospitals ; Humans ; Infant ; Infant mortality ; Infant Mortality - trends ; Male ; Mathematical models ; Medicine and Health Sciences ; Models, Statistical ; Mortality ; Pediatrics ; Population ; Premature birth ; Prospective Studies ; Retrospective Studies ; Risk ; Risk Assessment ; Surgery ; Survival ; United Kingdom - epidemiology
É parte de: PloS one, 2014-09, Vol.9 (8), p.e106806-e106806
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
Conceived and designed the experiments: RLK CD CB CW. Performed the experiments: RLK CD CB CW. Analyzed the data: RLK AW HG. Contributed reagents/materials/analysis tools: HG. Wrote the paper: RLK. Reviewed and developed the analyses: RLK CD CB CW AW HG. Reviewed and agreed the manuscript: RLK CD CB CW AW HG.
Competing Interests: The authors have declared that no competing interests exist.
Membership of the UKCSCHD (UK Collaborative Study of Congenital Heart Defects) is provided in the Acknowledgments.
Descrição: Congenital heart defects (CHDs) are a significant cause of death in infancy. Although contemporary management ensures that 80% of affected children reach adulthood, post-infant mortality and factors associated with death during childhood are not well-characterised. Using data from a UK-wide multicentre birth cohort of children with serious CHDs, we observed survival and investigated independent predictors of mortality up to age 15 years. Data were extracted retrospectively from hospital records and death certificates of 3,897 children (57% boys) in a prospectively identified cohort, born 1992-1995 with CHDs requiring intervention or resulting in death before age one year. A discrete-time survival model accounted for time-varying predictors; hazards ratios were estimated for mortality. Incomplete data were addressed through multilevel multiple imputation. By age 15 years, 932 children had died; 144 died without any procedure. Survival to one year was 79.8% (95% confidence intervals [CI] 78.5, 81.1%) and to 15 years was 71.7% (63.9, 73.4%), with variation by cardiac diagnosis. Importantly, 20% of cohort deaths occurred after age one year. Models using imputed data (including all children from birth) demonstrated higher mortality risk as independently associated with cardiac diagnosis, female sex, preterm birth, having additional cardiac defects or non-cardiac malformations. In models excluding children who had no procedure, additional predictors of higher mortality were younger age at first procedure, lower weight or height, longer cardiopulmonary bypass or circulatory arrest duration, and peri-procedural complications; non-cardiac malformations were no longer significant. We confirm the high mortality risk associated with CHDs in the first year of life and demonstrate an important persisting risk of death throughout childhood. Late mortality may be underestimated by procedure-based audit focusing on shorter-term surgical outcomes. National monitoring systems should emphasise the importance of routinely capturing longer-term survival and exploring the mechanisms of mortality risk in children with serious CHDs.
Editor: United States: Public Library of Science
Idioma: Inglês

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Modelling survival and mortality risk to 15 years of age for a national cohort of children with serious congenital heart defects diagnosed in infancy

Knowles, Rachel L ; Bull, Catherine ; Wren, Christopher ; Wade, Angela ; Goldstein, Harvey ; Dezateux, Carol Ricci, Zaccaria

United States: Public Library of Science

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