Prognostic Value of Biomarkers in Children and Adolescents With Orthostatic Intolerance

Yan, Hui‐Juan; Wang, Shuo; Cai, Hong; Zhang, Juan; Liu, Ping; Wang, Yuwen; Zou, Runmei; Wang, Cheng

doi:10.3389/fped.2021.752123

Cited by 5 publications

(2 citation statements)

References 70 publications

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“…[18] The prognostic outcomes for children with POTS under ORS treatment are different by sex. [12,13] Although the currently reported biological markers have been documented to be clinically effective in guiding the precise treatment of POTS in children, [19] the relationship between the sex and the prognosis of POTS in children has not yet been reported in the literature. [1,20] In our analysis of the dataset, we found that males had a better prognosis than females' children with POTS.…”

Section: Discussionmentioning

confidence: 99%

The influence of sex on the treatment of postural tachycardia syndrome in children

et al. 2023

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There are differences in postural tachycardia syndrome (POTS) incidence and manifestations in children between the sexes. However, there is limited evidence on how the gender affects the prognosis of POTS in children. This study is aimed at exploring the differences between the sexes regarding the prognosis of children with POTS. A retrospective study was conducted on children (n = 53; aged 6–14 years) who were diagnosed with POTS. All the POTS patients were given health education and autonomic function training, their water and salt intake was increased (oral rehydration salt III, 250 mL, Bid), and they were administered oral metoprolol (1 mg/kg per day) for 3 months. The prognosis was defined by the head-up tilt test results after treatment. It was observed that male and female children exhibited different trends in POTS prognosis. Further, the sex showed a stable independent effect on prognostic in children with POTS. To elaborate, females had a 503% increased risk of poor prognosis compared to males. We hence hypothesize that there is an association between the sex and the POTS prognosis in children. Female patients have a significantly higher risk of poor prognosis compared to males. A slight increase in the dose of oral rehydration salt could help lower the risk of poor prognosis in children with POTS. A higher absorption of total metoprolol, lower local concentrations, and slower metabolic excretion are documented in research in female POTS patients during treatment. It is recommended that the optimal dose of metoprolol should be lowered in female children undergoing treatment, to limit the risk of poor prognosis.

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Section: Discussionmentioning

confidence: 99%

The influence of sex on the treatment of postural tachycardia syndrome in children

et al. 2023

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“…For example, some investigators have reported that the number of previous episodes of syncope (4,5), onset age of syncope, and family history (6) were identified as promising predictors for recurrent syncope in VVS. In addition, others revealed that venous blood routine hemoglobin concentration and mean corpuscular hemoglobin were candidate biomarkers in predisposition to syncope recurrence (7). Further, heart rate variability (HRV), body mass index (BMI), and therapeutic regimens can also affect the prognosis of VVS (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Development of prognostic nomogram model to predict syncope recurrence in children with vasovagal syncope

Sun

Kang²,

Zhang³

et al. 2023

Front. Cardiovasc. Med.

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BackgroundsVasovagal syncope (VVS) is a common form of syncope. In children with VVS, recurrent syncope or presyncope can affect the physical and mental health of both children and parents, which markedly impairs quality of life.ObjectivesWe aimed to identify factors at baseline that can predict the recurrence of syncope or presyncope over a 5-year follow-up period, and further to develop a prognostic nomogram model.MethodsThis cohort is bidirectional in design. From July 2017 to August 2022, children with VVS were included and followed up every 3 to 6 months. Head-up Tilt Test (HUTT) was performed for diagnosing VVS. Data were analyzed using STATA software, and risk estimates are presented as hazard ratio (HR) and 95% confidence interval (CI).ResultsTotal 352 children with VVS who had complete information were included in this study. Median follow-up time was 22 months. Overall, supine mean arterial pressure (MAP-supine) in HUTT and baseline urine specific gravity (USG) were associated with the significant risk of syncope or presyncope recurrence (HR: 0.70 and 3.00, respectively; both P < 0.05). Calibration and discrimination analyses revealed that the addition of MAP-supine and USG can result in a better fit. A prognostic nomogram model based on significant factors annexed with five traditional promising factors was finally constructed, with strong discriminative and predictive abilities (C-index approaching 0.700, P < 0.05).ConclusionsOur findings indicated that MAP-supine and USG can independently predict the significant risk of syncope recurrence in children with VVS, and the prediction was more obvious in a nomogram model.

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Guidelines for the diagnosis and treatment of neurally mediated syncope in children and adolescents (revised 2024)

Wang,

Liao,

Wang

et al. 2024

World J Pediatr

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Background Significant progress has been made in the diagnosis and treatment of pediatric syncope since the publication of the “2018 Chinese Pediatric Cardiology Society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents” (“2018 Edition Guidelines”). Therefore, we have revised and updated it to assist pediatricians in effectively managing children with syncope. Data sources According to the “2018 Edition Guidelines”, the expert groups collected clinical evidence, evaluated preliminary recommendations, and then organized open-ended discussions to form the recommendations. This guideline was developed by reviewing the literature and studies in databases including PubMed, Cochrane, EMBASE, China Biomedical Database, and Chinese Journal Full-text Database up to April 2024. Search terms included “syncope”, “children”, “adolescents”, “diagnosis”, and “treatment.” Results The guidelines were based on the latest global research progress and were evidence-based. The classification of syncope etiology, diagnostic procedures, postural tests, such as the active standing test, head-up tilt test, and active sitting test, clinical diagnosis, and individualized treatment for neurally mediated syncope in pediatric population were included. Conclusions The guidelines were updated based on the latest literature. The concepts of sitting tachycardia syndrome and sitting hypertension were introduced and the comorbidities of neurally mediated syncope were emphasized. Some biomarkers used for individualized treatment were underlined. Specific suggestions were put forward for non-pharmacological therapies as well as the follow-up process. The new guidelines will provide comprehensive guidance and reference for the diagnosis and treatment of neurally mediated syncope in children and adolescents.

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Prognostic Value of Biomarkers in Children and Adolescents With Orthostatic Intolerance

Cited by 5 publications

References 70 publications

The influence of sex on the treatment of postural tachycardia syndrome in children

The influence of sex on the treatment of postural tachycardia syndrome in children

Development of prognostic nomogram model to predict syncope recurrence in children with vasovagal syncope

Guidelines for the diagnosis and treatment of neurally mediated syncope in children and adolescents (revised 2024)

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