Prediction of Survival in Infants with Congenital Diaphragmatic Hernia Based on Stomach Position, Surgical Timing, and Oxygenation Index
Prediction of Survival in Infants with Congenital Diaphragmatic Hernia Based on Stomach Position, Surgical Timing, and Oxygenation Index
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基于胃位置、手术时机和氧合指数的先天性膈疝婴儿的生存预测
DOI：
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发表时间：
2012
影响因子：
2
通讯作者：
J. Klein
中科院分区：
文献类型：
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作者：
P. Mann;F. Morriss;J. Klein
摘要目的探讨先天性腹股沟疝（CDH）患者生存的预测因素。 研究设计：回顾性分析1992年至2008年CDH患者（n = 81）的临床特征，包括与单中心生存相关的肺疾病严重程度（通过氧合指数（OI）测量）。 使用单变量和多变量逻辑回归、效应图和受试者工作特征（ROC）图分析数据。结果胃位于腹部者无一例死亡。 左胸胃位置预测生存率降低，ROC曲线下面积（AUC）= 0.70。出生后前12小时内平均OI ≤26预测所有患者的生存率≥50%，AUC = 0.86。OI效应图允许预测连续OI范围内的生存率。如果出生后12小时内平均OI>51，则无患者存活。对于术前OI值≤51的所有患者，延迟手术中位时间6天可提高生存概率。结论：出生后12小时内，胃在腹部的位置、手术延迟和较轻的心肺疾病（通过平均OI测量）可预测CDH患者的生存概率提高。 我们的CDH模型，使用平均OI，允许特定的个人生存概率预测范围内的OI值。
Abstract Objective To identify characteristics predictive of survival of patients with congenital diaphragmatic hernia (CDH). Study Design Retrospective analysis of clinical characteristics including severity of lung disease measured by oxygenation index (OI) associated with single-center survival in CDH patients (n = 81) from 1992 to 2008. Data were analyzed using univariate and multivariable logistic regression, effect plots, and receiver operating characteristic (ROC) plots. Results No patient died if the stomach was located in the abdomen. A left thoracic stomach position predicted decreased survival with ROC area under the curve (AUC) = 0.70. OI of ≤26 averaged over the first 12 hours of life predicted ≥50% survival for all patients, with AUC = 0.86. OI effect plots allow prediction of survival over a continuous OI range. No patient survived if mean OI was >51 in the first 12 hours of life. Delaying surgery for a median of 6 days improved survival probability for all patients with presurgery OI values ≤51. Conclusion Position of the stomach in the abdomen, delayed surgery, and less severe cardiopulmonary disease during the first 12 hours of life, as measured by mean OI, predicted improved survival probability among patients with CDH. Our CDH model, using mean OI, permits specific individual prediction of survival probability over a range of OI values.