Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Weill Cornell College of Medicine, New York, NY, USA.
Prenat Diagn. 2013 Mar;33(3):279-83. doi: 10.1002/pd.4059. Epub 2013 Feb 6.
The aim of this study was to develop a simple clinical algorithm for prediction of donor and recipient death using 'yes'or 'no' questions through the process of recursive partitioning for patients undergoing laser therapy for twin to twin transfusion syndrome (TTTS). The intent was to identify a subset of patients with very high specificity to whom clinical decisions would be simplified.
Secondary analysis of data retrospectively collected from laser procedures was performed for TTTS at NAFTNet centers from 2002 to 2009. Preoperative factors associated with donor and recipient death were identified by recursive partitioning regression analysis. Classification And Regression Trees (CARTs) were developed to refine specificity for prediction of death.
There were 466 TTTS patients from eight centers. CARTs were obtained for prediction of donor death. Improved specificity was achieved through recursive partitioning as demonstrated in receiver operator characteristic curves for prediction of death of the donor. There was less than optimal predictive ability for prediction of death in the recipient, as demonstrated by lack of generation of CARTs.
Recursive partitioning improves the specificity and refines the prediction of donor fetal and neonatal demise in TTTS treated with laser therapy. This has the potential to improve therapeutic choices and refine counseling regarding outcomes.
本研究旨在通过递归分区为接受激光治疗的双胎输血综合征（TTTS）患者开发一个简单的临床算法，通过“是”或“否”问题来预测供体和受者的死亡。目的是确定一组特异性非常高的患者，简化临床决策。
对 2002 年至 2009 年在 NAFTNet 中心接受激光治疗的 TTTS 患者进行回顾性数据的二次分析。通过递归分区回归分析确定与供体和受者死亡相关的术前因素。开发分类和回归树（CART）以提高对死亡预测的特异性。
共有来自 8 个中心的 466 例 TTTS 患者。为预测供体死亡生成了 CART。通过递归分区实现了特异性的提高，如供体死亡预测的接收器操作特征曲线所示。由于无法生成 CART，因此预测受者死亡的预测能力并不理想。
递归分区提高了接受激光治疗的 TTTS 患者中供体胎儿和新生儿死亡的特异性和预测能力。这有可能改善治疗选择并细化预后咨询。
