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Development and validation of a prognostic risk model for pediatric patients with left-to-right shunt congenital heart disease and heart failure

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Název: Development and validation of a prognostic risk model for pediatric patients with left-to-right shunt congenital heart disease and heart failure
Autoři: Li Mei Zhang, Yan Yun Huang, Yu Qin Huang, Yu Sheng Pang
Zdroj: Frontiers in Public Health, Vol 13 (2025)
Informace o vydavateli: Frontiers Media S.A., 2025.
Rok vydání: 2025
Sbírka: LCC:Public aspects of medicine
Témata: left-to-right shunt congenital heart disease, heart failure, pediatrics, prognostic prediction, risk model, survival analysis, Public aspects of medicine, RA1-1270
Popis: This retrospective study aimed to develop a reliable prognostic model for pediatric patients with left-to-right (L-R) shunt congenital heart disease (CHD) complicated by heart failure (HF), based on clinical data collected from 407 cases between August 2012 and June 2024. The cohort included 63.4% male patients with a median age of 4.33 months, and participants were randomly assigned to a training set (n = 284, 69.8%) and an internal validation set (n = 123, 30.2%). Univariate and multivariate Cox regression analyses combined with LASSO regression were used to identify key independent prognostic variables for overall survival (OS): modified Ross classification, N-terminal pro-brain natriuretic peptide (NT-proBNP) levels exceeding 5,743 pg./mL, elevated blood urea nitrogen (BUN), presence of shock, and history of thoracotomy. These factors were integrated to construct a nomogram, which showed strong prognostic performance—concordance indices (C-index) were 0.829 in the training set and 0.850 in the validation set. Survival analysis revealed significant differences in 3-, 6-, and 12-month OS between high-risk and low-risk groups stratified by nomogram scores. These findings suggest that the proposed nomogram, when applied to pediatric populations with L-R shunt CHD and HF who share baseline characteristics similar to those in our study, could serve as a promising auxiliary tool for early risk stratification and clinical decision-making.
Druh dokumentu: article
Popis souboru: electronic resource
Jazyk: English
ISSN: 2296-2565
Relation: https://www.frontiersin.org/articles/10.3389/fpubh.2025.1692007/full; https://doaj.org/toc/2296-2565
DOI: 10.3389/fpubh.2025.1692007
Přístupová URL adresa: https://doaj.org/article/6b457c9ea1124805a4c33c4e6f08e2e2
Přístupové číslo: edsdoj.6b457c9ea1124805a4c33c4e6f08e2e2
Databáze: Directory of Open Access Journals
Popis
Abstrakt:This retrospective study aimed to develop a reliable prognostic model for pediatric patients with left-to-right (L-R) shunt congenital heart disease (CHD) complicated by heart failure (HF), based on clinical data collected from 407 cases between August 2012 and June 2024. The cohort included 63.4% male patients with a median age of 4.33 months, and participants were randomly assigned to a training set (n = 284, 69.8%) and an internal validation set (n = 123, 30.2%). Univariate and multivariate Cox regression analyses combined with LASSO regression were used to identify key independent prognostic variables for overall survival (OS): modified Ross classification, N-terminal pro-brain natriuretic peptide (NT-proBNP) levels exceeding 5,743 pg./mL, elevated blood urea nitrogen (BUN), presence of shock, and history of thoracotomy. These factors were integrated to construct a nomogram, which showed strong prognostic performance—concordance indices (C-index) were 0.829 in the training set and 0.850 in the validation set. Survival analysis revealed significant differences in 3-, 6-, and 12-month OS between high-risk and low-risk groups stratified by nomogram scores. These findings suggest that the proposed nomogram, when applied to pediatric populations with L-R shunt CHD and HF who share baseline characteristics similar to those in our study, could serve as a promising auxiliary tool for early risk stratification and clinical decision-making.
ISSN:22962565
DOI:10.3389/fpubh.2025.1692007