Body mass index is a promising predictor of response to oral rehydration saline in children with vasovagal syncope

Abstract

Background: Vasovagal syncope (VVS) greatly impairs quality of life. The therapeutic efficacy of oral rehydration saline (ORS) for unselected VVS patients is not satisfactory due to the diverse mechanisms of the disease. Body mass index (BMI) was demonstrated to reflect blood volume to a certain extent. Therefore, the present study explored the capability of BMI to predict the therapeutic response of children with VVS to ORS treatment. Methods: Seventy-four children with VVS who visited the Syncope Unit of Pediatrics at Peking University First Hospital from November 2010 to June 2019 receiving ORS treatment were enrolled for this retrospective case-control study. A comparison of demographic, clinical, and hemodynamic characteristics was performed between responders and non-responders. The correlation between baseline BMI and response time was analyzed. To determine the value of baseline BMI in predicting the therapeutic efficacy of ORS in children with VVS, a receiver operating characteristic curve analysis was performed. Results: Fifty-two children were identified as responders, and the remaining 22 children were identified as non-responders. The baseline BMI of the responders was much lower than that of the non-responders (16.4 [15.5, 17.8] kg/m 2 vs . 20.7 ±e6 kg/m 2 , P < 0.001), and baseline BMI was positively correlated with response time in the head-up tilt test after adjusting for sex ( r = 0.256, 95% confidence interval [CI]: 0.067–0.439, P = 0.029). The area under the receiver operating characteristic curve of baseline BMI was 0.818 (95% CI: 0.704–0.932, P < 0.001), and an optimal cut-off value of 18.9 kg/m 2 yielded a sensitivity of 83% and a specificity of 73% to predict the efficacy of ORS in VVS. Conclusion: Prior to treatment, baseline BMI is a promising predictor of response to ORS in children with VVS.

The predictive value of urine specific gravity in the diagnosis of vasovagal syncope in children and adolescents

“…Tao et al [ 22 ] also reported the predictive value of acceleration index (AI) in postural training effect of VVS children, the sensitivity and specificity of predicting effective training were 85.0 and 69.2% when AI cut-off value was 26.77. Tao et al [ 23 ] also observed that BMI predicted the intervention effect of VVS children on ORS, when BMI cut-off value was 18.9 kg/m 2 , the sensitivity and specificity for predicting the effective intervention of ORS in VVS was 83 and 73%. In this study, the USG of children and adolescents with VVS was significantly lower than that of healthy control children ( P < 0.01), the area under the ROC curve was 0.751, standard error was 0.035, and 95% confidence interval (0.683, 0.819) suggested that USG was of moderate predictive value in the diagnosis of VVS.…”

Poincaré Plot Can Be a Useful Tool to Select Potential Responders to Metoprolol Therapy in Children with Vasovagal Syncope

“… 1 The severity of the disease was assessed by the syncope symptom score based on the frequency of syncope episodes. 29 , 46 , 47 The syncope symptom score was as follows: 0, no syncope; 1, once/month; 2, two to four times/month; 3, two to seven times/week; 4, more than once per day. 29 , 30 , 46 , 47 The baseline syncope symptom score was evaluated by the average frequency of syncope episodes within 3 months before metoprolol treatment.…”

“… 29 , 46 , 47 The syncope symptom score was as follows: 0, no syncope; 1, once/month; 2, two to four times/month; 3, two to seven times/week; 4, more than once per day. 29 , 30 , 46 , 47 The baseline syncope symptom score was evaluated by the average frequency of syncope episodes within 3 months before metoprolol treatment. After 3 months of metoprolol treatment, all the patients were followed up by hospitalization, outpatient clinics or telephone, and their frequency of syncope episodes during the metoprolol treatment and the treatment compliance were collected, recorded, and checked by professional investigators.…”

“…That is, if the syncope symptom score at the end of 3 months of metoprolol therapy, which was evaluated by the average frequency of syncope episodes during the 3 months of metoprolol treatment, decreased by at least one point from the baseline syncope symptom score, the therapy was considered effective, otherwise, it was considered ineffective. 29 , 46 , 47 The patients were divided into the effective group (responders) and the ineffective group (nonresponders) depending on their response to the metoprolol therapy.…”

Can pediatric vasovagal syncope be individually managed?

“…The AUC was 0.8. Using 18.9 kg/m 2 as the cutoff value of BMI yielded a sensitivity of 83% and a specificity of 73% in predicting the therapeutic response to ORS therapy in VVS children [7]. BMI is a promising predictive index and is useful in improving the treatment efficacy of ORS for VVS patients because BMI is easy to obtain through non-invasive measurements.…”