Survival in Congenital Diaphragmatic Hernia: Use of Predictive Equations in the ECMO Population
Survival in Congenital Diaphragmatic Hernia: Use of Predictive Equations in the ECMO Population
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DOI：
10.1159/000319064
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发表时间：
2011-01-01
期刊：
影响因子：
2.5
通讯作者：
Short, Billie Lou
中科院分区：
文献类型：
--
作者：
Hoffman, Suma B.;Massaro, An N.;Short, Billie Lou
背景：Wilford Hall/Santa Rosa(WHSR)和先天性横隔疝研究小组(CDHSG)已经提出了预测CDH患者生存的方程。CDHSG根据包含出生体重和5分钟阿普加评分的Logistic回归方程对风险进行分层，而WHSR组使用最大Po(2)和最大PCo(2)之间的差值作为风险指数。这些模型并没有专门应用于CDH ECMO(体外膜氧合)人群，这是一组死亡风险最高的人群。目的：评估WHSR和CDHSG预测方程在需要ECMO生命支持的CDH患者中的应用。方法：对1993-2007年间采用ECMO治疗的婴幼儿先天性巨结肠进行单中心回顾性分析。使用受试者工作曲线(ROC)分析将预测结果和实际结果进行比较，其中曲线下面积(AUC)为1表示预测结果与实际结果100%一致。Kaplan-Meier分析也被用来比较根据每个预测模型进行风险分类的患者的存活率。ECMO前最低PCO(2)同样被评估为生存的预测因子。结果：在研究期间接受ECMO治疗的62例CDH患者的总存活率为50%。CDHSG方程没有区分存活和死亡(AUC0.55，p=0.499)。改良的WHSR公式对生存的判别力更好(AUC0.71，p=0.004)。体外循环前可达到的最低PCO(2)具有最高的AUC(0.723，p=0.003)。ECMO前最低PCO(2)和50 mm Hg的患者存活率为56%，而那些>；70 mm Hg的患者存活率为0。结论：用来预测CDH患者存活率的方程可能不会区分ECMO人群中的幸存者和死亡者。在这一高危人群中，与反映肺发育不良程度的通风和氧合指标相比，出生体重和阿普加评分等因素在估计死亡风险方面没有那么关键。版权所有(C)2010 S.Karger AG，巴塞尔
Background: Equations have been proposed by the Wilford Hall/Santa Rosa (WHSR) and Congenital Diaphragmatic Hernia Study Group (CDHSG) for predicting survival in patients with CDH. The CDHSG stratifies risk based on a logistic regression equation incorporating birth weight and 5-min Apgar score, while the WHSR group uses the difference between maximum pO(2) and maximum pCO(2) as an index of risk. These models have not been applied specifically to the CDH ECMO (extracorporeal membrane oxygenation) population, a group at highest mortality risk. Objectives: To evaluate the WHSR and CDHSG predictive equations when applied to a population of patients with CDH requiring ECMO life support. Methods: A single-center retrospective review was conducted on infants with CDH treated with ECMO between 1993 and 2007. Predicted and actual outcomes were compared using receiver operating curve (ROC) analyses in which an area under the curve (AUC) of 1 denotes 100% agreement between predicted and actual outcomes. Kaplan-Meier analyses were also used to compare survival of patients who were risk-categorized according to each prediction model. Minimum pre-ECMO pCO(2) was likewise evaluated as a predictor of survival. Results: Overall survival was 50% in 62 CDH patients treated with ECMO during the study period. The CDHSG equation did not discriminate between survivors and nonsurvivors (AUC 0.55, p = 0.499). The modified WHSR formula showed better discrimination of survival (AUC 0.71, p = 0.004). Lowest achievable pre-ECMO pCO(2) had the highest AUC (0.723, p = 0.003). Patients with minimum pre-ECMO pCO(2) < 50 mm Hg had 56% survival, while those with >70 mm Hg had 0% survival. Conclusions: Equations proposed to predict survival in CDH patients may not discriminate survivors from nonsurvivors in the ECMO population. In this highest risk group, factors such as birth weight and Apgar score are less critical in estimating mortality risk than indicators of ventilation and oxygenation that reflect the degree of pulmonary hypoplasia. Copyright (C) 2010 S. Karger AG, Basel