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Du X, Tao C, Wang Y, Sun Y, Zhang Q, Zhang C, Liu P, Wang Y, Liao Y, Du J, Jin H. Twenty-Four-Hour Urinary Sodium Excretion Predicts Therapeutic Effectiveness of Oral Rehydration Saline in Pediatric Vasovagal Syncope. CHILDREN (BASEL, SWITZERLAND) 2022; 9:992. [PMID: 35883976 PMCID: PMC9321383 DOI: 10.3390/children9070992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022]
Abstract
The study was designed to explore whether 24-hour urinary sodium excretion could predict the therapeutic effectiveness of oral rehydration saline in pediatric cases of vasovagal syncope. Eighty children suffering from vasovagal syncope with oral rehydration saline treatment in Department of Pediatrics, Peking University First Hospital, China, were recruited into the study. They were followed up for 3 (2, 3) months after treatment. Pre-treatment demographic, clinical, head-up tilt test-based hemodynamic and laboratory variables were compared between responders and non-responders. After univariate analysis, variables with p value < 0.05 in the comparison between responders and non-responders were further analyzed by binary logistic regression analysis. Receiver operating characteristic (ROC) curve was conducted to assess the value in predicting effectiveness of oral rehydration saline treatment. The results showed that 33 cases were responders, and 47 were non-responders. Blood sodium (138 ± 2 mmol/L vs. 139 ± 2 mmol/L, p < 0.05) and pre-treatment 24-hour urinary sodium excretion (74 ± 29 mmol/24 h vs. 109 (93, 141) mmol/24 h, p < 0.001) were lower in responders than in non-responders. The baseline 24-hour urinary sodium excretion was positively correlated to the duration from tilting to the positive response appearance in head-up tilt test (r = 0.289, p < 0.01). The cut-off value of baseline 24-hour urinary sodium excretion of the therapeutic effectiveness of oral rehydration saline on vasovagal syncope cases was 83 mmol/24 h, yielding a sensitivity of 87% and a specificity of 73% with AUC of 0.842 (p < 0.001). In conclusion, 24-hour urinary sodium excretion could be a useful biomarker to predict the therapeutic response to oral rehydration saline in pediatric cases of vasovagal syncope.
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Affiliation(s)
- Xiaojuan Du
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (X.D.); (C.T.); (Y.W.); (Y.S.); (Q.Z.); (C.Z.); (P.L.); (Y.W.); (J.D.)
| | - Chunyan Tao
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (X.D.); (C.T.); (Y.W.); (Y.S.); (Q.Z.); (C.Z.); (P.L.); (Y.W.); (J.D.)
| | - Yaru Wang
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (X.D.); (C.T.); (Y.W.); (Y.S.); (Q.Z.); (C.Z.); (P.L.); (Y.W.); (J.D.)
| | - Yan Sun
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (X.D.); (C.T.); (Y.W.); (Y.S.); (Q.Z.); (C.Z.); (P.L.); (Y.W.); (J.D.)
| | - Qingyou Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (X.D.); (C.T.); (Y.W.); (Y.S.); (Q.Z.); (C.Z.); (P.L.); (Y.W.); (J.D.)
| | - Chunyu Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (X.D.); (C.T.); (Y.W.); (Y.S.); (Q.Z.); (C.Z.); (P.L.); (Y.W.); (J.D.)
| | - Ping Liu
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (X.D.); (C.T.); (Y.W.); (Y.S.); (Q.Z.); (C.Z.); (P.L.); (Y.W.); (J.D.)
| | - Yuli Wang
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (X.D.); (C.T.); (Y.W.); (Y.S.); (Q.Z.); (C.Z.); (P.L.); (Y.W.); (J.D.)
| | - Ying Liao
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (X.D.); (C.T.); (Y.W.); (Y.S.); (Q.Z.); (C.Z.); (P.L.); (Y.W.); (J.D.)
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (X.D.); (C.T.); (Y.W.); (Y.S.); (Q.Z.); (C.Z.); (P.L.); (Y.W.); (J.D.)
- Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing 100191, China
| | - Hongfang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (X.D.); (C.T.); (Y.W.); (Y.S.); (Q.Z.); (C.Z.); (P.L.); (Y.W.); (J.D.)
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Liu P, Zeng X, Mei W, Wang Y, Zou R, Wang C. The predictive value of urine specific gravity in the diagnosis of vasovagal syncope in children and adolescents. Ital J Pediatr 2021; 47:93. [PMID: 33865429 PMCID: PMC8052542 DOI: 10.1186/s13052-021-01043-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 04/07/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Vasovagal syncope (VVS) is a kind of common neurally mediated syncope in children and adolescents. Decreased blood volume is one of the pathogenesis of VVS. The diagnosis of VVS is mainly based on head-up tilt test (HUTT), but some complications may easily occur when HUTT induces syncope. To find a simple and safe VVS diagnosis method can improve the VVS diagnosis efficiency. AIMS OF THE STUDY This was a prospective study. The study will explore the predictive value of urine specific gravity (USG) in the diagnosis of VVS in children and adolescents. PATIENTS AND METHODS Ninety-seven cases (43 males and 54 females, aged 4 to 16 years old, with an average age of 10.91 ± 2.18 years old) hospitalized due to unexplained premonitory syncope or syncope and diagnosed with VVS through HUTT from September 2014 to September 2018 were selected as VVS group. During the same period, 91 cases of children and adolescents, including 45 males and 46 females, aged from 5 to 15 years old, who underwent a healthy examination were matched as a control (control group). USG was measured in both groups. RESULTS The USG of VVS group was significantly lower than that of the control group (P < 0.01), and USG of females was lower than that of males in VVS group (P = 0.045). The sensitivity and specificity of USG in predicting VVS were evaluated by ROC curve. The area under the ROC curve was 0.751, standard error was 0.035, and 95% CI (0.683, 0.819) suggested that USG was of moderate predictive value in the diagnosis of VVS. As cut-off value of USG was 1.0185, the sensitivity and specificity and diagnostic coincidence rate of VVS were 74.39, 66.04 and 69.68%, respectively. CONCLUSION There are less USG in children and adolescents with VVS, especially lower USG in females. Therefore, USG has predictive value in the diagnosis of VVS in children and adolescents.
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Affiliation(s)
- Ping Liu
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China
- Department of Clinical Nursing, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Xingfang Zeng
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China
- Department of Clinical Nursing, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Wanzhen Mei
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China
- Department of Clinical Nursing, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Yuwen Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Runmei Zou
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Cheng Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China.
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Tao CY, Chen S, Li XY, Tang CS, Du JB, Jin HF. Body mass index is a promising predictor of response to oral rehydration saline in children with vasovagal syncope. Chin Med J (Engl) 2020; 134:463-468. [PMID: 33617185 PMCID: PMC7909309 DOI: 10.1097/cm9.0000000000001168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Indexed: 11/26/2022] Open
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/m2vs. 20.7 ±e6 kg/m2, 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/m2 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.
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Affiliation(s)
- Chun-Yan Tao
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
- Research Unit of Clinical Diagnosis and Treatment of Pediatric Syncope and Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Selena Chen
- Division of Biological Sciences, University of California, San Diego, CA 92093, USA
| | - Xue-Ying Li
- Department of Medical Statistics, Peking University First Hospital, Beijing 100034, China
| | - Chao-Shu Tang
- Department of Physiology and Pathophysiology, Peking University Health Science Center, Beijing 100191, China
| | - Jun-Bao Du
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
- Research Unit of Clinical Diagnosis and Treatment of Pediatric Syncope and Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Hong-Fang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
- Research Unit of Clinical Diagnosis and Treatment of Pediatric Syncope and Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100730, China
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Liao Y, Du J. Pathophysiology and Individualized Management of Vasovagal Syncope and Postural Tachycardia Syndrome in Children and Adolescents: An Update. Neurosci Bull 2020; 36:667-681. [PMID: 32367250 PMCID: PMC7271077 DOI: 10.1007/s12264-020-00497-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/31/2020] [Indexed: 12/12/2022] Open
Abstract
Vasovagal syncope (VVS) and postural tachycardia syndrome (POTS) are the main forms of orthostatic intolerance in pediatrics and both are underlying causes of neurally-mediated syncope. In recent years, increasing attention has been paid to the management of VVS and POTS in children and adolescents. A number of potential mechanisms are involved in their pathophysiology, but the leading cause of symptoms varies among patients. A few studies thus have focused on the individualized treatment of VVS or POTS based on selected hemodynamic parameters or biomarkers that can predict the therapeutic effect of certain therapies and improve their effectiveness. This review summarizes the latest developments in individualized treatment of VVS and POTS in children and indicates directions for further research in this field.
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Affiliation(s)
- Ying Liao
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China.
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Zhang W, Zou R, Wu L, Luo X, Xu Y, Li F, Lin P, Xie Z, Wang C. The changes of electrolytes in serum and urine in children with neurally mediated syncope cured by oral rehydration salts. Int J Cardiol 2017; 233:125-129. [DOI: 10.1016/j.ijcard.2016.12.138] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/30/2016] [Accepted: 12/19/2016] [Indexed: 02/01/2023]
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Zhang Q, Liao Y, Tang C, Du J, Jin H. Twenty-four-hour urinary sodium excretion and postural orthostatic tachycardia syndrome. J Pediatr 2012; 161:281-4. [PMID: 22424949 DOI: 10.1016/j.jpeds.2012.01.054] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 12/27/2011] [Accepted: 01/30/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate whether 24-hour urinary sodium excretion could be an indicator of the effectiveness of salt supplementation in children with postural orthostatic tachycardia syndrome (POTS). STUDY DESIGN The patient group comprised 30 children with POTS, and the control group comprised 10 healthy children. Serum sodium and 24-hour urinary sodium excretion were measured in all children, and the relationship between 24-hour urinary sodium and symptom severity was analyzed in the 30 patients. At 1 month after initiation of salt supplementation, the receiver operating characteristic curve was used to explore the probability of correctly discriminating responders to salt supplementation from nonresponders using 24-hour urinary sodium excretion as an indicator. RESULTS Patients with POTS had lower 24-hour urinary sodium excretion than controls (P = .022). Symptom severity was negatively correlated with 24-hour urinary sodium excretion (OR, -0.754; P = .000). The receiver operating characteristic curve demonstrated a sensitivity of 76.9% and specificity of 93% for correct prediction of responders and nonresponders to salt supplementation when a 24-hour urinary sodium excretion of 124 mmol/24 hours was used as the cutoff value. CONCLUSION Our results indicate that 24-hour sodium excretion of <124 mmol/24 hours is an indicator of the effectiveness of salt supplementation in children and adolescents with POTS.
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Affiliation(s)
- Qingyou Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
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MITRO PETER, MUDRÁKOVÁ KLAUDIA, MIČKOVÁ HELENA, DUDÁŠ JÁN, KIRSCH PETER, VALOČIK GABRIEL. Hemodynamic Parameters and Heart Rate Variability during a Tilt Test in Relation to Gene Polymorphism of Renin-Angiotensin and Serotonin System. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:1571-80. [DOI: 10.1111/j.1540-8159.2008.01228.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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