{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T23:06:36Z","timestamp":1781737596357,"version":"3.54.5"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>\n                    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\u202fmonths, and participants were randomly assigned to a training set (\n                    <jats:italic>n<\/jats:italic>\n                    =\u202f284, 69.8%) and an internal validation set (\n                    <jats:italic>n<\/jats:italic>\n                    =\u202f123, 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\u202fpg.\/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\u2014concordance 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.\n                  <\/jats:p>","DOI":"10.3389\/fpubh.2025.1692007","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T07:04:01Z","timestamp":1762412641000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Development and validation of a prognostic risk model for pediatric patients with left-to-right shunt congenital heart disease and heart failure"],"prefix":"10.3389","volume":"13","author":[{"given":"Li Mei","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan Yun","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu Qin","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu Sheng","family":"Pang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1093\/ije\/dyz009","article-title":"Global birth prevalence of congenital heart defects 1970-2017: updated systematic review and meta-analysis of 260 studies","volume":"48","author":"Liu","year":"2019","journal-title":"Int J Epidemiol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1016\/S2352-4642(23)00051-2","article-title":"Current status and challenges in prenatal and neonatal screening, diagnosis, and management of congenital heart disease in China","volume":"7","author":"Zhang","year":"2023","journal-title":"Lancet Child Adolesc Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1007\/s12098-015-1861-9","article-title":"Evaluation of left to right shunts by the pediatrician: how to follow, when to refer for intervention?","volume":"82","author":"Vijayalakshmi","year":"2015","journal-title":"Indian J Pediatr"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"4370","DOI":"10.1002\/ehf2.13760","article-title":"A year in heart failure: an update of recent findings","volume":"8","author":"Stretti","year":"2021","journal-title":"ESC Heart Fail"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e015941","DOI":"10.1136\/bmjopen-2017-015941","article-title":"Trend analysis of mortality rates and causes of death in children under 5 years old in Beijing, China from 1992 to 2015 and forecast of mortality into the future: an entire population-based epidemiological study","volume":"7","author":"Cao","year":"2017","journal-title":"BMJ Open"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e2022056294","DOI":"10.1542\/peds.2022-056294","article-title":"Lesion-specific congenital heart disease mortality trends in children: 1999 to 2017","volume":"150","author":"Lynn","year":"2022","journal-title":"Pediatrics"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e006101","DOI":"10.1161\/CIRCHEARTFAILURE.119.006101","article-title":"Epidemiology and outcomes of acute decompensated heart failure in children","volume":"13","author":"Lasa","year":"2020","journal-title":"Circ Heart Fail"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1890","DOI":"10.1016\/j.jacc.2021.08.056","article-title":"Predicting major adverse cardiovascular events in children with age-adjusted NT-proBNP","volume":"78","author":"Palm","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"345","DOI":"10.3390\/jpm15080345","article-title":"Prognostic models in heart failure: Hope or hype?","volume":"15","author":"Skoularigkis","year":"2025","journal-title":"Journal of Personalized Medicine"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1007\/s12630-015-0537-2","article-title":"Predicting outcomes: is there utility in risk scores?","volume":"63","author":"Wijeysundera","year":"2016","journal-title":"Can J Anesth\/J Can Anesth"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"994483","DOI":"10.3389\/fcvm.2022.994483","article-title":"Comparison of conventional scoring systems to machine learning models for the prediction of major adverse cardiovascular events in patients undergoing coronary computed tomography angiography","volume":"9","author":"Ghorashi","year":"2022","journal-title":"Frontiers in Cardiovascular Medicine"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1321","DOI":"10.1016\/j.cardfail.2021.05.028","article-title":"Combination biomarkers for risk stratification in patients with chronic heart failure biomarkers prognostication in HF","volume":"27","author":"Feng","year":"2021","journal-title":"J Card Fail"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2230","DOI":"10.1002\/ehf2.12680","article-title":"Multimarker approach including CRP, sST2 and GDF-15 for prognostic stratification in stable heart failure","volume":"7","author":"Kuster","year":"2020","journal-title":"ESC heart failure"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"832","DOI":"10.3390\/electronics8080832","article-title":"Machine learning interpretability: a survey on methods and metrics","volume":"8","author":"Carvalho","year":"2019","journal-title":"Electronics"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"84","DOI":"10.3760\/cma.j.cn112140-20200619-00737","article-title":"Recommendations for diagnosis and treatment of heart failure in children (2020 revised edition)","volume":"59","author":"Tian","year":"2021","journal-title":"Zhonghua Er Ke Za Zhi"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"42","DOI":"10.3390\/children6030042","article-title":"Management of congenital heart disease: state of the art; part I-acyanotic heart defects","volume":"6","author":"Rao","year":"2019","journal-title":"Children (Basel)"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1097\/01.pec.0000618172.27947.c3","article-title":"Early recognition and emergency treatment of sepsis and septic shock in children","volume":"36","author":"Hilarius","year":"2020","journal-title":"Pediatr Emerg Care"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e232","DOI":"10.1161\/CIR.0000000000000525","article-title":"Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association","volume":"136","author":"van Diepen","year":"2017","journal-title":"Circulation"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1564","DOI":"10.1177\/0885066619871452","article-title":"Multiple organ dysfunction syndrome","volume":"35","author":"Gourd","year":"2020","journal-title":"J Intensive Care Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e12067","DOI":"10.1002\/pul2.12067","article-title":"Pulmonary hypertensive crisis in children with pulmonary arterial hypertension undergoing cardiac catheterization","volume":"12","author":"Li","year":"2022","journal-title":"Pulm Circ"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1364","DOI":"10.1200\/JCO.2007.12.9791","article-title":"How to build and interpret a nomogram for cancer prognosis","volume":"26","author":"Iasonos","year":"2008","journal-title":"J Clin Oncol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1016\/j.recesp.2011.01.019","article-title":"Estrategias para la elaboraci\u00f3n de modelos estad\u00edsticos de regresi\u00f3n","volume":"64","author":"N\u00fa\u00f1ez","year":"2011","journal-title":"Rev Esp Cardiol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"2359","DOI":"10.1177\/0962280216680245","article-title":"Use of the concordance index for predictors of censored survival data","volume":"27","author":"Brentnall","year":"2018","journal-title":"Stat Methods Med Res"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"294","DOI":"10.7326\/0003-4819-157-4-201208210-00014","article-title":"Beyond the usual prediction accuracy metrics: reporting results for clinical decision making","volume":"157","author":"Localio","year":"2012","journal-title":"Ann Intern Med"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"25","DOI":"10.5334\/gh.831","article-title":"Survival of left-to-right shunt repair in children with pulmonary arterial hypertension at a tertiary hospital in a low-to-middle-income country","volume":"16","author":"Arafuri","year":"2021","journal-title":"Glob Heart"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1002\/clc.23173","article-title":"Prediction of spontaneous closure of ventricular septal defect and guidance for clinical follow-up","volume":"42","author":"Li","year":"2019","journal-title":"Clin Cardiol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1295","DOI":"10.1007\/s00246-012-0306-8","article-title":"The Ross classification for heart failure in children after 25 years: a review and an age-stratified revision","volume":"33","author":"Ross","year":"2012","journal-title":"Pediatr Cardiol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1007\/s00431-022-04737-9","article-title":"The value of modified Ross score in the evaluation of children with severe lower respiratory tract infection admitted to the pediatric intensive care unit","volume":"182","author":"Hassan","year":"2023","journal-title":"Eur J Pediatr"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1007\/s10741-014-9422-2","article-title":"The potential and limitations of plasma BNP measurement in the diagnosis, prognosis, and management of children with heart failure due to congenital cardiac disease: an update","volume":"19","author":"Cantinotti","year":"2014","journal-title":"Heart Fail Rev"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"998","DOI":"10.1253\/circj.cj-09-0535","article-title":"The role of N-terminal pro-B-type natriuretic peptide in the diagnosis of congestive heart failure in children","volume":"74","author":"Sugimoto","year":"2010","journal-title":"Circ J"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"6459","DOI":"10.26355\/eurrev_202209_29745","article-title":"Correlation of mortality with proBNP and precipitating factors of acute heart failure in patients presenting to a medical emergency of tertiary care hospital: an observational study from North India","volume":"26","author":"Bhatia","year":"2022","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1716","DOI":"10.1007\/s00246-023-03259-x","article-title":"N-terminal pro-B-type natriuretic peptide as a marker of severity of heart failure in children with congenital heart diseases","volume":"44","author":"Chowdhury","year":"2023","journal-title":"Pediatr Cardiol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1016\/j.medcle.2018.08.005","article-title":"Renal function and acute heart failure outcome","volume":"151","author":"Llauger","year":"2018","journal-title":"Med Clin (Barc)"},{"key":"ref34","first-page":"176","article-title":"Expression and clinical significance of serum sST2, BDNF, CTnI, and BUN\/Cr in patients with heart failure","volume":"29","author":"Xie","year":"2023","journal-title":"Altern Ther Health Med"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1002\/clc.23532","article-title":"Predicting 90\u202fday acute heart failure readmission and death using machine learning-supported decision analysis","volume":"44","author":"Sarijaloo","year":"2021","journal-title":"Clin Cardiol"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1016\/j.cnc.2018.05.006","article-title":"Cardiogenic shock in the septic patient: early identification and evidence-based management","volume":"30","author":"Tartavoulle","year":"2018","journal-title":"Crit Care Nurs Clin North Am"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1315","DOI":"10.1002\/ejhf.1922","article-title":"Epidemiology, pathophysiology and contemporary management of cardiogenic shock-a position statement from the heart failure Association of the European Society of cardiology","volume":"22","author":"Chioncel","year":"2020","journal-title":"Eur J Heart Fail"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"100309","DOI":"10.1016\/j.jhlto.2025.100309","article-title":"Risk factors affecting mortality in pediatric heart transplantation: a comprehensive review of pre-and post-transplant contributors","volume":"9","author":"Elizer","year":"2025","journal-title":"JHLT Open"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1161\/CIRCULATIONAHA.114.012033","article-title":"Achievements in congenital heart defect surgery: a prospective, 40-year study of 7038 patients","volume":"131","author":"Erikssen","year":"2015","journal-title":"Circulation"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1186\/s12887-021-02935-2","article-title":"Characteristics of in-hospital mortality of congenital heart disease (CHD) after surgical treatment in children from 2005 to 2017: a single-center experience","volume":"21","author":"Zheng","year":"2021","journal-title":"BMC Pediatr"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1017\/S1047951123000331","article-title":"Paediatric heart failure\u2013understanding the pathophysiology and the current role of cardiac biomarkers in clinical practice","volume":"33","author":"McGinn","year":"2023","journal-title":"Cardiol Young"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1345","DOI":"10.1016\/j.athoracsur.2016.01.071","article-title":"Mortality trends in pediatric and congenital heart surgery: an analysis of the society of thoracic surgeons congenital heart surgery database","volume":"102","author":"Jacobs","year":"2016","journal-title":"Ann Thorac Surg"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"100331","DOI":"10.1016\/j.jhlto.2025.100331","article-title":"Pediatric heart failure: current approach and treatment","volume":"9","author":"Olsen","year":"2025","journal-title":"JHLT Open"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"740","DOI":"10.3390\/children9050740","article-title":"Novel biomarkers of heart failure in pediatrics","volume":"9","author":"Senekovi\u010d Kojc","year":"2022","journal-title":"Children"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1692007\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T07:04:23Z","timestamp":1762412663000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1692007\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,6]]},"references-count":44,"alternative-id":["10.3389\/fpubh.2025.1692007"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1692007","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,6]]},"article-number":"1692007"}}