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Cited by 45Congenital Heart Disease StudiesCardiovascular Conditions and TreatmentsCardiac and Coronary Surgery Techniques

An Elevated Low Cardiac Output Syndrome Score Is Associated With Morbidity in Infants After Congenital Heart Surgery

Ulate, Kalia P., Yanay, Ofer, Jeffries, Howard, Baden, Harris, Di Gennaro, Jane L., Zimmerman, Jerry·2017·Pediatric Critical Care Medicine
DOI 10.1097/pcc.0000000000000979
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Abstract

OBJECTIVES: To evaluate an empirically derived Low Cardiac Output Syndrome Score as a clinical assessment tool for the presence and severity of Low Cardiac Output Syndrome and to examine its association with clinical outcomes in infants who underwent surgical repair or palliation of congenital heart defects. DESIGN: Prospective observational cohort study. SETTING: Cardiac ICU at Seattle Children's Hospital. PATIENTS: Infants undergoing surgical repair or palliation of congenital heart defects. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Clinical and laboratory data were recorded hourly for the first 24 hours after surgery. A Low Cardiac Output Syndrome Score was calculated by assigning one point for each of the following: tachycardia, oliguria, toe temperature less than 30°C, need for volume administration in excess of 30 mL/kg/d, decreased near infrared spectrometry measurements, hyperlactatemia, and need for vasoactive/inotropes in excess of milrinone at 0.5 μg/kg/min. A cumulative Low Cardiac Output Syndrome Score was determined by summation of Low Cardiac Output Syndrome Score on arrival to cardiac ICU, and 8, 12, and 24 hours postoperatively. Scores were analyzed for association with composite morbidity (prolonged mechanical ventilation, new infection, cardiopulmonary arrest, neurologic event, renal dysfunction, necrotizing enterocolitis, and extracorporeal life support) and resource utilization. Fifty-four patients were included. Overall composite morbidity was 33.3%. Median peak Low Cardiac Output Syndrome Score and cumulative Low Cardiac Output Syndrome Score were higher in patients with composite morbidity (3 [2-5] vs 2 [1-3]; p = 0.003 and 8 [5-10] vs 2.5 [1-5]; p < 0.001)]. Area under the receiver operating characteristic curve for cumulative Low Cardiac Output Syndrome Score versus composite morbidity was 0.83, optimal cutoff of greater than 6. Patients with cumulative Low Cardiac Output Syndrome Score greater than or equal to 7 had higher morbidity, longer duration of mechanical ventilation, cardiac ICU, and hospital length of stay (all p ≤ 0.001). After adjusting for other relevant variables, peak Low Cardiac Output Syndrome Score and cumulative Low Cardiac Output Syndrome Score were independently associated with composite morbidity (odds ratio, 2.57; 95% CI, 1.12-5.9 and odds ratio, 1.35; 95% CI, 1.09-1.67, respectively). CONCLUSION: Higher peak Low Cardiac Output Syndrome Score and cumulative Low Cardiac Output Syndrome Score were associated with increased morbidity and resource utilization among infants following surgery for congenital heart defects and might be a useful tools in future cardiac intensive care research. Independent validation is required.

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Crossref · 10.1097/pcc.0000000000000979

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  • Both Ulate et al. and Aslan et al. integrated lactate measurement into their LCOS scoring systems as a marker of tissue perfusion.

    “Both Ulate et al. [30] and Aslan et al. [33] integrated lactate measurement into their LCOS scoring systems as a marker of tissue perfusion.”

    From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [30]

  • A combined clinical-biological scoring system for LCOS, incorporating qualitative CRT and quantitative toe temperature assessments, has been associated with increased postoperative morbidity.

    “A combined clinical–biological scoring system for low cardiac output syndrome (LCOS), incorporating qualitative CRT and quantitative toe temperature assessments, has been associated with increased postoperative morbidity [30].”

    From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [30]

  • Ulate et al. developed a scoring system for infants with congenital heart disease undergoing surgery; the LCOSS assigns one point for each of tachycardia, oliguria, decreased toe temperature, fluid requirement, decreased cerebral oxygen saturation measured by NIRS, elevated lactate levels, and inotropic/vasoactive support.

    “Ulate et al. developed a scoring system for infants with congenital heart disease undergoing surgery. The LCOSS assigns one point for each of the following: tachycardia, oliguria, decreased toe temperature, fluid requirement, decreased cerebral oxygen saturation measured by NIRS, elevated lactate levels, and inotropic/vasoactive support [30].”

    From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [30]

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Authors
Ulate, K. P., Yanay, O., Jeffries, H., Baden, H., Di Gennaro, J. L., & Zimmerman, J.
Affiliations
Seattle Children's Hospital (US)
ORCID
Venue
Pediatric Critical Care Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2017-01
Volume
18
Issue
1
Pages
26-33
ISSN
1529-7535 (ISSN-L)
DOI
10.1097/pcc.0000000000000979
OpenAlex
W2530312398
Cited by
45
References
24
Citations by year
2026: 5 · 2025: 4 · 2024: 6 · 2023: 7 · 2022: 5 · 2021: 4 · 2020: 4 · 2019: 3 · 2018: 3 · 2017: 4
FWCI
3.13
Type
journal article
Language
en
Open access
closed
Locations
  • Pediatric Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiovascular Conditions and Treatments
  • Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
Keywords
low cardiac output syndrome, congenital heart disease, infants, congenital heart surgery, surgical repair, palliative care, clinical risk score, postoperative morbidity, mechanical ventilation duration, renal dysfunction, necrotizing enterocolitis, extracorporeal life support, near-infrared spectroscopy, hyperlactatemia, prognostic scoring
MeSH terms
Cardiac Output, Low, Decision Support Techniques, Female, Heart Defects, Congenital, Cardiac Surgical Procedures, Humans, Infant, Infant, Newborn, Male, Postoperative Complications, Prospective Studies, Sensitivity and Specificity, Severity of Illness Index, Logistic Models, Treatment Outcome

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