Predictive value of esophageal deviation index for clinical outcomes of patients with left-sided congenital diaphragmatic hernia
Objective To evaluate the predictive value of postnatal esophageal deviation index for clinical outcomes of fetuses with left-sided congenital diaphragmatic hernia(L-CDH).Methods This retrospective study analyzed the clinical data of 103 neonates with prenatally diagnosed L-CDH who were admitted to Guangzhou Women and Children's Medical Center from January 2016 to February 2023.These patients were divided into the survival group(n=82)and the death group(n=21)according to the outcomes,and the extracorporeal membrane oxygenation(ECMO)group(n=25)and the non-ECMO group(n=78)according to whether ECMO support was required.Thoracoabdominal X-ray screening was performed on all neonates within 24 h after admission and the esophageal deviation index and cardiac deviation index were calculated.Independent sample t-test or Fisher's exact probability test were used to analyze the differences in general condition and postnatal imaging features between different groups.Receiver operating characteristic(ROC)curve was used to evaluate the value of postnatal imaging features in predicting the prognosis of L-CDH.Results The esophageal deviation index and the cardiac deviation index of neonates in the survival group were lower than those in the death group[(10.5± 5.3)％vs.(18.0±4.5)％,t=-5.47;(37.7±7.1)％vs.(42.8±8.2)％,t=-2.62;both P＜0.05],while that were both higher in the ECMO group compared with the non-ECMO group[(18.0±4.3)％vs.(10.1±5.2)％,t=6.34;(42.4±7.9)％vs.(37.6±7.1)％,t=2.63;both P＜0.05].ROC curve showed that the area under the curve(AUC)for predicting the need for ECMO support was 0.879(95％CI:0.805-0.953)for esophageal deviation index and 0.712(95％CI:0.570-0.854)for cardiac deviation index,with the optimal cut-off values of 11.7％and 41.7％,respectively.The AUC for predicting the survival rate in patients with L-CDH by esophageal deviation index and cardiac deviation index were 0.854(95％CI:0.761-0.947)and 0.735(95％CI:0.582-0.887),respectively,with the corresponding optimal cut-off values of 15.8％and 41.7％.Conclusion Postnatal esophageal deviation index is of value in predicting the need for ECMO support and survival rate in patients with L-CDH.
万方数据
维普
