Admission systolic blood pressure below the 57th percentile was associated with increased in-hospital mortality in pediatric heart failure (aHR 1.86; 95% CI 1.07-3.26).
Cohort (n=2,545)
Yes
Do admission blood pressure percentiles predict in-hospital mortality in children with pediatric heart failure?
Admission blood pressure percentiles, specifically SBP <57th or >91st and DBP <83rd, are associated with increased in-hospital mortality in pediatric heart failure.
Effect estimate: aHR 1.86 (95% CI 1.07-3.26)
Background Pediatric heart failure (PHF) carries a high mortality burden, yet the prognostic value of admission blood pressure (BP) remains poorly defined, and evidence-based thresholds for risk stratification are lacking. Methods This retrospective, multicenter cohort study included 2545 children diagnosed with PHF upon admission across 30 Chinese centers (2013–2022). BP was standardized into age-, sex-, and height-specific percentiles. Associations with in-hospital mortality were analyzed using restricted cubic splines (RCS), machine learning covariate selection, and sensitivity analyses, stratified by sex, age, and etiology. Results Systolic BP (SBP) percentiles showed a U-shaped association with mortality, with the lowest risk at the 63.8th percentile. Risk increased below the 57th percentile adjusted hazard ratio (aHR) = 1.86, 95% confidence interval (CI) 1.07–3.26 and above the 91st percentile (aHR = 1.69, 95% CI = 0.85–3.33), a relationship primarily driven by infants/toddlers. Diastolic BP (DBP) percentiles showed a linear inverse association, with risk increasing below the 83rd percentile (aHR = 1.65, 95% CI = 1.09–2.50). Sex-stratified analyses suggested that girls were more vulnerable to high SBP (≥ 91st: aHR = 3.84, 95% CI = 1.31–11.20), whereas boys were more susceptible to low DBP ( 0.05). Conclusion This study establishes novel BP percentile thresholds for mortality risk stratification in patients with PHF (SBP: 57th–91st; DBP: 83rd–100th) and provides preliminary evidences for sex- and age-differential hemodynamic management, although validation is required. Graphical abstract
Gao et al. (Fri,) conducted a cohort in Pediatric heart failure (n=2,545). Admission blood pressure percentiles was evaluated on In-hospital mortality (aHR 1.86, 95% CI 1.07-3.26). Admission systolic blood pressure below the 57th percentile was associated with increased in-hospital mortality in pediatric heart failure (aHR 1.86; 95% CI 1.07-3.26).