Prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia: a systematic review and meta-analysis
Prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia: a systematic review and meta-analysis
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DOI：
10.1007/s00383-022-05232-w
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发表时间：
2022-09-14
影响因子：
1.8
通讯作者：
Usui, Noriaki
中科院分区：
文献类型：
--
作者：
Masahata, Kazunori;Yamoto, Masaya;Usui, Noriaki
目的本研究旨在评估先天性膈疝（CDH）胎儿死亡率的产前预测因素。方法系统检索文献，对肺头比（LHR）、符合预期LHR（o/e-LHR）、符合预期胎儿肺体积（TPV）等指标进行评价（o/e-TFLV），肺胸横面积比（L/T比值）、肝和胃的胸内疝以及侧疝，使用阈值预测先天性髋关节脱位胎儿的死亡率。使用QUADAS-2工具评估研究质量。构建分层汇总受试者工作特征曲线。结果共纳入50篇文献。QUADAS-2工具在所有参数的多个领域中识别出高偏倚风险。在这些参数中，o/e-LHR <25%、o/e-TFLV <25%和L/T比值< 0.08的死亡率诊断比值比分别为11.98 [95%置信区间（CI）4.65-30.89]、11.14（95% CI 5.19-23.89）和10.28（95% CI 3.38-31.31）。存在肝疝和心后胎胃位置对死亡率的预测值相似。结论本系统评价提示o/e-LHR、o/e-TFLV和L/T比值同样是孤立性CDH胎儿新生儿死亡率的良好预测因子。
Purpose This study aimed to evaluate prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia (CDH). Methods A systematic literature search was performed to identify relevant observational studies that evaluated the ability of lung-to-head ratio (LHR), observed-to-expected LHR (o/e-LHR), observed-to-expected total fetal lung volume (o/e-TFLV), lung-to-thorax transverse area ratio (L/T ratio), intrathoracic herniation of the liver and the stomach, and side of diaphragmatic hernia, using a threshold for the prediction of mortality in fetuses with CDH. Study quality was assessed using the QUADAS-2 tool. Hierarchical summary receiver operating characteristic curves were constructed. Results A total of 50 articles were included in this meta-analysis. The QUADAS-2 tool identified a high risk of bias in more than one domain scored in all parameters. Among those parameters, the diagnostic odds ratio of mortality with o/e-LHR < 25%, o/e-TFLV < 25%, and L/T ratio < 0.08 were 11.98 [95% confidence interval (CI) 4.65-30.89], 11.14 (95% CI 5.19-23.89), and 10.28 (95% CI 3.38-31.31), respectively. The predictive values for mortality were similar between the presence of liver herniation and retrocardiac fetal stomach position. Conclusions This systematic review suggests that o/e-LHR, o/e-TFLV, and L/T ratio are equally good predictors of neonatal mortality in fetuses with isolated CDH.