Fortes Filho J B, Dill J C, Ishizaki A, Aguiar W W S, Silveira R C, Procianoy R S
Department of Ophthalmology, Newborn Section, Medical School, Federal University of Rio Grande do Sul and Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.
Ophthalmologica. 2009;223(3):177-82. doi: 10.1159/000197114. Epub 2009 Jan 28.
To evaluate the use of the Score for Neonatal Acute Physiology and Perinatal Extension (SNAPPE-II) at admission to predict the development of retinopathy of prematurity (ROP) among very-low-birth-weight preterm babies.
A prospective cohort study included 304 infants screened for ROP from July 2004 to October 2007. The main outcomes were the development of any stage ROP and severe ROP. The main variable was the SNAPPE-II obtained at admission. Seventeen risk factors for ROP were studied by univariate analysis (chi(2) and Student's t test). A simple descriptive analysis was used for the SNAPPE-II (mean, median, standard deviation and interquartile range: p25-p75). Logistic regression and receiver-operating characteristic (ROC) curve were calculated for SNAPPE-II. Ophthalmological examinations started at the 6th week of life and were repeated until the 45th week of corrected gestational age (GA).
The mean GA and mean birth weight of the whole cohort were 30.3 weeks (+/-2.2) and 1,209.2 g (+/-277.7), respectively. The median SNAPPE-II among non-ROP and ROP patients were 6.0 and 15.0, respectively (p = 0.001). When compared with severe ROP patients (25.0) there was also a significant difference (p = 0.003). After logistic regression, the SNAPPE-II adjusted odds ratio for ROP was 1.024. The area under the ROC curve was 0.62 (95% confidence interval: 0.55-0.70, p < 0.001). The best discriminative cutoff value was 8.5 (sensitivity: 68%; specificity: 54%; positive predictive value: 37.3%; negative predictive value: 80.6%).
The SNAPPE-II values at admission were significantly higher among babies with ROP, suggesting a positive association between higher scores with the development of ROP, but after adjusted logistic regression and ROC curve results, the SNAPPE-II scores at admission did not enhance the assessment of risk for ROP.
评估极低出生体重早产儿入院时使用新生儿急性生理学及围生期扩展评分（SNAPPE-II）预测早产儿视网膜病变（ROP）发生情况的价值。
一项前瞻性队列研究纳入了2004年7月至2007年10月间304例接受ROP筛查的婴儿。主要结局为任何阶段ROP及重度ROP的发生情况。主要变量为入院时获得的SNAPPE-II。通过单因素分析（卡方检验和学生t检验）研究了17个ROP危险因素。对SNAPPE-II进行简单描述性分析（均值、中位数、标准差和四分位数间距：p25-p75）。计算SNAPPE-II的逻辑回归和受试者工作特征（ROC）曲线。眼科检查从出生后第6周开始，直至矫正胎龄（GA）第45周重复进行。
整个队列的平均GA和平均出生体重分别为30.3周（±2.2）和1209.2 g（±277.7）。非ROP和ROP患者的SNAPPE-II中位数分别为6.0和15.0（p = 0.001）。与重度ROP患者（25.0）相比也有显著差异（p = 0.003）。逻辑回归后，SNAPPE-II对ROP的调整优势比为1.024。ROC曲线下面积为0.62（95%置信区间：0.55-0.70，p < 0.001）。最佳判别临界值为8.5（敏感性：68%；特异性：54%；阳性预测值：37.3%；阴性预测值：80.6%）。
ROP婴儿入院时的SNAPPE-II值显著更高，提示高分与ROP发生之间存在正相关，但经过调整的逻辑回归和ROC曲线结果显示，入院时的SNAPPE-II评分并未增强对ROP风险的评估。
