Utilizing Preoperative Laboratory Indicators to Mitigating Postoperative Multiorgan Dysfunction Following Cardiac Surgery in Children with Congenital Heart Disease at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia
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Date
2026-09-16
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Addis Ababa University
Abstract
Background: Postoperative multiorgan dysfunction syndrome (MODS) is a serious complication following pediatric congenital heart surgery and is associated with high mortality. In resource-limited settings, advanced monitoring tools are often unavailable, making early risk identification challenging. Preoperative laboratory indicators may provide simple and accessible predictors of postoperative organ dysfunction.
Objective: To determine the prevalence of postoperative MODS and evaluate whether preoperative laboratory indicators predict postoperative organ dysfunction among children undergoing congenital heart surgery at Cardiac center and Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.
Methods: A retrospective cohort study was conducted among 166 pediatric patients who underwent congenital heart surgery with cardiopulmonary bypass between January 2023 and September 2025. Preoperative laboratory parameters, including serum creatinine, hemoglobin, platelet count, liver enzymes, INR, and arterial blood gas values, were extracted from medical records. Postoperative organ dysfunction was assessed using an adapted and modified PELOD-2C score, with a score >6 defining MODS. Bivariable and multivariable linear regression analyses were performed to identify independent predictors of postoperative organ dysfunction severity.
Results: Postoperative MODS occurred in 4 patients (2.4%). Although infrequent, MODS was strongly associated with prolonged ICU stay, longer mechanical ventilation, increased vasopressor use, and higher mortality (75% vs. 0.6%, p < 0.001). In multivariable analysis, higher surgical complexity (RACHS-1 Category 3; β = 3.83, p < 0.001), elevated preoperative INR (β = 1.30, p < 0.001), lower platelet count (β = −0.0022 per 10³/μL increase, p = 0.032), and severe preoperative malnutrition (β = 1.22, p = 0.006) were independently associated with higher postoperative PELOD-2C scores. Preoperative serum creatinine and hemoglobin were not independently predictive after adjustment.
Conclusion: Postoperative MODS was uncommon but highly lethal in this cohort. Surgical complexity, coagulation abnormalities, thrombocytopenia, and severe malnutrition were significant predictors of postoperative organ dysfunction. Incorporating simple preoperative laboratory markers and nutritional assessment into perioperative risk stratification may improve early identification of high-risk children in resource limited settings.
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Utilizing Preoperative Laboratory Indicators to mitigating Postoperative Multiorgan Dysfunction following Cardiac Surgery in children