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Background <p>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.</p> Methods <p>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.</p> Results <p>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&#xa0;= 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&#xa0;= 1.09–2.50). Sex-stratified analyses suggested that girls were more vulnerable to high SBP (≥ 91st: aHR = 3.84, 95% CI&#xa0;= 1.31–11.20), whereas boys were more susceptible to low DBP (&lt; 83rd: aHR = 2.21, 95% CI =&#xa0;1.16–4.20). Etiology-stratified analyses confirmed consistency across major diagnostic categories (<i>P</i> values for all interactions &gt; 0.05).</p> Conclusion <p>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.</p> Graphical abstract <p></p>

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Admission blood pressure percentiles and in-hospital mortality in pediatric heart failure: a multicenter retrospective cohort study

  • 期刊论文

  • 发表日期：

    2026年4月1日

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  • Jing Gao,
  • Shi-Yuan Huang,
  • Yu-Xing Yuan,
  • Bo Pan,
  • Fang-Jie Wang,
  • Zhi Chen,
  • Ying Guo,
  • Xing Shen,
  • Xue-Cun Liang,
  • Yan-Yan Liang,
  • Yan-Lin Xing,
  • Hui-Li Zhang,
  • Ying-Qian Zhang,
  • Chun-Hong Xie,
  • Li Li,
  • Zhi-Lin Huang,
  • Hui-Chao Sun,
  • Min Zheng,
  • Ling-Juan Liu,
  • Tie-Wei Lv,
  • Xue-Mei Lian,
  • Zi-Pu Li,
  • Xiao-Hua Liang,
  • Jie Tian

摘要

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 (< 83rd: aHR = 2.21, 95% CI = 1.16–4.20). Etiology-stratified analyses confirmed consistency across major diagnostic categories (P values for all interactions > 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