PDF(Pubmed)
Abstract：
Objectives: Congestive hepatopathy is a significant complication for children suffering from right-sided heart disease (RHD). We hypothesize that hospitalized pediatric patients with ascites will have congestive hepatopathy leading to advanced liver disease if their cardiac condition is RHD versus non-right-sided heart disease (NRHD). Methods: This is a retrospective cohort study of pediatric patients who presented with an ascites diagnosis (ICD-10 R18) and at least one cardiac diagnosis. Patient demographics, past medical history, laboratory values, imaging results, calculated clinical scores (e.g., APRI, FIB-4), treatment, length of stay (LOS), and death at hospital discharge were analyzed. Results: Of the 136 patients with ascites, 21 patients presented with a primary cardiac disease (12 in RHD and 9 in NRHD). Of these patients, eight (38%) were female, and nine (43%) were White, seven (33%) were Black, and five (24%) were unknown. The RHD group had a mean age of 5.1 Y (vs. 9.5 Y in NRHD). The mean APRI score in RHD patients was 2.87, and it was 0.85 in NRDH. Treatments were similar, with most patients requiring diuretics (11 RHD (92%) vs. 8 NRDH (89%)); 5 RHD (42%) vs. 4 NRDH (44%) required inotropic support. RHD patients had a longer LOS, with an average of 92 days vs. 52 days for NRDH patients. Overall, each group had one death at discharge (8% RHD vs. 11% NRDH). Conclusions: In the realm of children with ascites, the subset grappling with congestive heart disease paints a unique picture. In this context, ascites stands as an elusive predictor of liver decompensation, defying conventional diagnostic pathways.
摘要：
目的：充血性肝病是患有右侧心脏病（RHD）的儿童的重要并发症。我们假设，如果住院的小儿腹水患者的心脏状况是RHD与非右侧心脏病（NRHD），则会患有充血性肝病，从而导致晚期肝病。方法：这是一项回顾性队列研究，对患有腹水诊断（ICD-10R18）和至少一项心脏诊断的儿科患者进行了研究。患者人口统计学，既往病史,实验室值，成像结果,计算的临床评分(例如，APRI,FIB-4),治疗,停留时间(LOS)并对出院时的死亡情况进行分析。结果:136例腹水患者中,21例患者患有原发性心脏病（RHD12例，NRHD9例）。在这些病人中,八位（38%）为女性，9人（43%）是白人，七个（33%）是黑人，5人（24%）不详。RHD组的平均年龄为5.1岁(与9.5Y在NRHD中）。RHD患者的平均APRI评分为2.87，NRDH为0.85。治疗方法相似，大多数患者需要利尿剂（11RHD（92％）与8NRDH（89%））；5RHD（42%）与4NRDH(44%)需要正性肌力支持。RHD患者的LOS较长,平均92天52天为NRDH患者。总的来说,每组有1例出院时死亡(8%RHDvs.11%NRDH)。结论：在腹水儿童领域，与充血性心脏病作斗争的子集描绘了一幅独特的画面。在这种情况下，腹水是肝脏失代偿的一个难以捉摸的预测指标，无视传统的诊断途径。
