Ambalavanan Namasivayam, Carlo Waldemar A, Shankaran Seetha, Bann Carla M, Emrich Steven L, Higgins Rosemary D, Tyson Jon E, O'Shea T Michael, Laptook Abbot R, Ehrenkranz Richard A, Donovan Edward F, Walsh Michele C, Goldberg Ronald N, Das Abhik
Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35249, USA.
Pediatrics. 2006 Nov;118(5):2084-93. doi: 10.1542/peds.2006-1591.
The goals were to identify predictor variables and to develop scoring systems and classification trees to predict death/disability or death in infants with hypoxic-ischemic encephalopathy.
Secondary analysis of data from the multicenter, randomized, controlled, National Institute of Child Health and Human Development Neonatal Research Network trial of hypothermia in hypoxic-ischemic encephalopathy was performed. Data for 205 neonates diagnosed as having hypoxic-ischemic encephalopathy were studied. Logistic regression analysis was performed by using clinical and laboratory variables available within 6 hours of birth, with death or moderate/severe disability at 18 to 22 months or death as the outcomes. By using the identified variables and odds ratios, scoring systems to predict death/disability or death were developed, weighting each predictor in proportion to its odds ratio. In addition, classification and regression tree analysis was performed, with recursive partitioning and automatic selection of optimal cutoff points for variables. Correct classification rates for the scoring systems, classification and regression tree models, and early neurologic examination were compared.
Correct classification rates were 78% for death/disability and 71% for death with the scoring systems, 80% and 77%, respectively, with the classification and regression tree models, and 67% and 73% with severe encephalopathy in early neurologic examination. Correct classification rates were similar in the hypothermia and control groups.
Among neonates diagnosed as having hypoxic-ischemic encephalopathy, the classification and regression tree model, but not the scoring system, was superior to early neurologic examination in predicting death/disability. The 3 models were comparable in predicting death. Only a few components of the early neurologic examination were associated with poor outcomes. These scoring systems and classification trees, if validated, may help in assessments of prognosis and may prove useful for risk-stratification of infants with hypoxic-ischemic encephalopathy for clinical trials.
确定预测变量，开发评分系统和分类树，以预测缺氧缺血性脑病婴儿的死亡/残疾或死亡情况。
对多中心、随机、对照的美国国立儿童健康与人类发展研究所新生儿研究网络缺氧缺血性脑病低温治疗试验的数据进行二次分析。研究了205例被诊断为缺氧缺血性脑病的新生儿的数据。采用出生后6小时内可用的临床和实验室变量进行逻辑回归分析，以18至22个月时的死亡或中度/重度残疾或死亡作为结局。利用确定的变量和比值比，开发预测死亡/残疾或死亡的评分系统，根据每个预测因素的比值比进行加权。此外，进行分类和回归树分析，采用递归划分和自动选择变量的最佳切点。比较了评分系统、分类和回归树模型以及早期神经学检查的正确分类率。
评分系统对死亡/残疾的正确分类率为78%，对死亡的正确分类率为71%；分类和回归树模型分别为80%和77%；早期神经学检查中重度脑病的正确分类率为67%和73%。低温治疗组和对照组的正确分类率相似。
在被诊断为缺氧缺血性脑病的新生儿中，分类和回归树模型在预测死亡/残疾方面优于早期神经学检查，而评分系统则不然。这三种模型在预测死亡方面相当。早期神经学检查中只有少数成分与不良结局相关。这些评分系统和分类树如果得到验证，可能有助于预后评估，并可能对缺氧缺血性脑病婴儿进行临床试验的风险分层有用。
