构建预测影响先天性食管闭锁预后危险因素评分系统的研究

Establishment of predictive scoring system for prognosis of congenital esophageal atresia

目的:构建预测食管闭锁(congenital esophageal atresia,CEA)新生儿院内病死的量化评分系统。方法:比较2004年3月至2016年5月在重庆医科大学附属儿童医院收诊的198例CEA患儿相关指标,分析导致CEA预后不良的独立危险因素并量化赋值。结果:CEA病死率为18.1%(n=36)。单因素分析发现病死组早产、低出生体质量、吻合口漏、长距型CEA、呼吸衰竭、手术后败血症、呼吸窘迫综合征、气胸及休克患病率高于存活组(P<0.05)。logistic回归分析发现吻合口漏(OR=10.75,95%CI=3.113~37.128)、呼吸衰竭(OR=4.104,95%CI=2.292~7.355)、手术后败血症(OR=3.564,95%CI=1.516~8.375)、低出生体质量(OR=8.379,95%CI=3.357~20.917)与高病死率有关(P<0.05)。依据各危险变量赋值构建的受试者工作曲线的曲线下面积为0.902,界点分数为2,灵敏度、特异度、阳性及阴性预测值分别为0.861、0.827、0.525、0.964。低危险(0~1分)、中危险(2~4分)、高危险组(≥5分)病死率分别为3.6%、49.1%、100%,3组比较差异有统计学意义(χ2=73.198,P=0.000)。结论:吻合口漏、呼吸衰竭、手术后败血症、低出生体质量与CEA预后不良有关,在总分为8分的本系统中,得分越高预后越差。

Objective：To investigate the risk factors for in-hospital mortality in neonates with congenital esophageal atresia（CEA）and to develop a prediction score model for prognosis. Methods：All infants with CEA treated in the Children＇s Hospital of Chongqing Medical University between Mar 2004 and May 2016 were included in present study. Risk factors were compared between survivor group and non-survivor group infants. A prediction score model was developed according to the regression coefficients of risk factors.Results：The mortality was 18.1%（36/198）. In univariate analysis,higher incidence of prematurity,low birth weight,long gap,anastomotic leak,respiratory failure,postoperative sepsis,respiratory distress syndrome,pneumothorax and septic shock were found in nonsurvivor group when compared with those of survivor group（P〈0.05）. In logistic regression analysis,anastomotic leak（OR=10.75,95%CI=3.113 to 37.128）,respiratory failure（OR=4.104,95%CI=2.292 to 7.355）,postoperative sepsis（OR=3.564,95%CI=1.516 to 8.375）and low birth weight（OR=8.379,95%CI=3.357 to 20.917）were associated with the high mortality（P〈0.05）. A predictive score system was developed and the area under receiver operating characteristic curve of the score was 0.902（95%CI=0.859 to 0.945） for death from CEA. At the cutoff point of 2,a sensitivity of 0.861,a specificity of 0.827,a positive predictive value of 0.525 and a negative predictive value of 0.964 were obtained from this model. Three risk groups were defined：the ‘low＇risk group（0 to 1 score）,the‘moderate＇risk group（2 to 4 score）and the ‘high＇risk group（≥5 score）. Mortality rate significantly increased in the ‘high＇risk group（100%）when compared with the ‘low＇or ‘moderate＇risk group（3.6%,49.1%,respectively,χ2=73.198,P=0.000）. Conclusion：Anastomotic leak,respiratory failure,postoperative sepsis and low birth weight are independent risk factors for mortality of CEA. Infants with higher score had higher morality according to this predictive score system.