PDF(Pubmed)
Abstract：
OBJECTIVE: Although many prognostic factors in neonates with congenital diaphragmatic hernia (CDH) have been described, no consensus thus far has been reached on which and how many factors are involved. The aim of this study is to analyze the association of multiple prenatal and postnatal factors with 1-month mortality of neonates with CDH and to construct a nomogram prediction model based on significant factors.
METHODS: A retrospective analysis of neonates with CDH at our center from 2013 to 2022 was conducted. The primary outcome was 1-month mortality. All study variables were obtained either prenatally or on the first day of life. Risk for 1-month mortality of CDH was quantified by odds ratio (OR) with 95% confidence interval (CI) in multivariable logistic regression models.
RESULTS: After graded multivariable adjustment, six factors were found to be independently and consistently associated with the significant risk of 1-month mortality in neonates with CDH, including gestational age of prenatal diagnosis (OR, 95% CI, P value: 0.845, 0.772 to 0.925, < 0.001), observed-to-expected lung-to-head ratio (0.907, 0.873 to 0.943, < 0.001), liver herniation (3.226, 1.361 to 7.648, 0.008), severity of pulmonary hypertension (6.170, 2.678 to 14.217, < 0.001), diameter of defect (1.560, 1.084 to 2.245, 0.017), and oxygen index (6.298, 3.383 to 11.724, < 0.001). Based on six significant factors identified, a nomogram model was constructed to predict the risk for 1-month mortality in neonates with CDH, and this model had decent prediction accuracy as reflected by the C-index of 94.42%.
CONCLUSIONS: Our findings provide evidence for the association of six preoperational and intraoperative factors with the risk of 1-month mortality in neonates with CDH, and this association was reinforced in a nomogram model.
METHODS: A retrospective analysis of neonates with CDH at our center from 2013 to 2022 was conducted. The primary outcome was 1-month mortality. All study variables were obtained either prenatally or on the first day of life. Risk for 1-month mortality of CDH was quantified by odds ratio (OR) with 95% confidence interval (CI) in multivariable logistic regression models.
RESULTS: After graded multivariable adjustment, six factors were found to be independently and consistently associated with the significant risk of 1-month mortality in neonates with CDH, including gestational age of prenatal diagnosis (OR, 95% CI, P value: 0.845, 0.772 to 0.925, < 0.001), observed-to-expected lung-to-head ratio (0.907, 0.873 to 0.943, < 0.001), liver herniation (3.226, 1.361 to 7.648, 0.008), severity of pulmonary hypertension (6.170, 2.678 to 14.217, < 0.001), diameter of defect (1.560, 1.084 to 2.245, 0.017), and oxygen index (6.298, 3.383 to 11.724, < 0.001). Based on six significant factors identified, a nomogram model was constructed to predict the risk for 1-month mortality in neonates with CDH, and this model had decent prediction accuracy as reflected by the C-index of 94.42%.
CONCLUSIONS: Our findings provide evidence for the association of six preoperational and intraoperative factors with the risk of 1-month mortality in neonates with CDH, and this association was reinforced in a nomogram model.
摘要：
目的：尽管已经描述了先天性膈疝（CDH）新生儿的许多预后因素，迄今为止，尚未就涉及哪些因素和多少因素达成共识。这项研究的目的是分析多种产前和产后因素与CDH新生儿1个月死亡率的关系，并基于显着因素构建列线图预测模型。
方法：对我中心2013-2022年新生儿CDH进行回顾性分析。主要结果是1个月死亡率。所有研究变量均在产前或生命的第一天获得。在多变量逻辑回归模型中，通过比值比（OR）和95％置信区间（CI）量化CDH1个月死亡率的风险。
结果：经过分级多变量调整后，在患有CDH的新生儿中，有六个因素与1个月死亡率的显著风险独立且持续相关，包括产前诊断的胎龄(OR，95%CI,P值:0.845,0.772~0.925,<0.001),观察到的预期肺头比（0.907，0.873至0.943，<0.001），肝疝（3.226，1.361至7.648，0.008），肺动脉高压的严重程度（6.170，2.678至14.217，<0.001），缺陷直径（1.560，1.084至2.245，0.017），和氧指数（6.298，3.383至11.724，<0.001）。根据确定的六个重要因素，建立了一个列线图模型来预测CDH新生儿1个月死亡率的风险，该模型具有较好的预测精度，C指数为94.42%。
结论：我们的发现为六项术前和术中因素与CDH新生儿1个月死亡风险的相关性提供了证据。这种关联在列线图模型中得到了加强。
方法：对我中心2013-2022年新生儿CDH进行回顾性分析。主要结果是1个月死亡率。所有研究变量均在产前或生命的第一天获得。在多变量逻辑回归模型中，通过比值比（OR）和95％置信区间（CI）量化CDH1个月死亡率的风险。
结果：经过分级多变量调整后，在患有CDH的新生儿中，有六个因素与1个月死亡率的显著风险独立且持续相关，包括产前诊断的胎龄(OR，95%CI,P值:0.845,0.772~0.925,<0.001),观察到的预期肺头比（0.907，0.873至0.943，<0.001），肝疝（3.226，1.361至7.648，0.008），肺动脉高压的严重程度（6.170，2.678至14.217，<0.001），缺陷直径（1.560，1.084至2.245，0.017），和氧指数（6.298，3.383至11.724，<0.001）。根据确定的六个重要因素，建立了一个列线图模型来预测CDH新生儿1个月死亡率的风险，该模型具有较好的预测精度，C指数为94.42%。
结论：我们的发现为六项术前和术中因素与CDH新生儿1个月死亡风险的相关性提供了证据。这种关联在列线图模型中得到了加强。
