Chowdhury Shahryar M, Graham Eric M, Atz Andrew M, Bradley Scott M, Kavarana Minoo N, Butts Ryan J
Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
Semin Thorac Cardiovasc Surg. 2016;28(2):425-433. doi: 10.1053/j.semtcvs.2016.04.004. Epub 2016 Apr 19.
The ability to quantify patient-specific hospital mortality risk before the Norwood procedure remains elusive. This study aimed to develop an accurate and clinically feasible score to assess the risk of hospital mortality in neonates undergoing the Norwood procedure. All patients (n = 549) in the publically available Pediatric Heart Network Single Ventricle Reconstruction trial database were included in the analysis. Patients were randomly divided into a derivation (75%) and validation (25%) cohort. Preoperative factors found to be associated with mortality upon univariable analysis (P < 0.2) were included in the logistic regression model. The score was derived by including variables independently associated with mortality (P < 0.05). A 20-point score using 6 variables (birth weight, clinical syndrome or abnormal karyotype, surgeon Norwood volume or year, anatomic subtype, ascending aorta size, and obstructed pulmonary venous return) was developed using relative magnitudes of the covariates׳ odds ratio. The score was then tested in the validation cohort. In weighted regression analysis, model predicted risk of mortality correlated closely with actual rates of mortality in the derivation (R = 0.87, P < 0.01) and validation cohorts (R = 0.82, P < 0.01). Patients were classified as low (score: 0-5), medium (6-10), or high risk (>10). Mortality differed significantly between risk groups in both the derivation (6% vs 22% vs 77%, P < 0.01) and validation (4% vs 30% vs 53%, P < 0.01) cohorts. This mortality score is accurate in determining risk of hospital mortality in neonates undergoing planned Norwood operations. The score has the potential to be used in clinical practice to aid in risk assessment before surgery. Clinical trial registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00115934.
在诺伍德手术前对患者个体的医院死亡风险进行量化的能力仍然难以实现。本研究旨在开发一种准确且临床可行的评分系统，以评估接受诺伍德手术的新生儿的医院死亡风险。公开可用的儿科心脏网络单心室重建试验数据库中的所有患者（n = 549）均纳入分析。患者被随机分为推导队列（75%）和验证队列（25%）。单变量分析中发现与死亡率相关（P < 0.2）的术前因素被纳入逻辑回归模型。通过纳入与死亡率独立相关的变量（P < 0.05）得出评分。利用协变量优势比的相对大小，开发了一个使用6个变量（出生体重、临床综合征或异常核型、实施诺伍德手术的外科医生手术量或年份、解剖亚型、升主动脉大小和肺静脉回流受阻）的20分评分系统。然后在验证队列中对该评分进行测试。在加权回归分析中，模型预测的死亡风险与推导队列（R = 0.87，P < 0.01）和验证队列（R = 0.82，P < 0.01）中的实际死亡率密切相关。患者被分为低风险（评分：0 - 5）、中等风险（6 - 10）或高风险（>10）。在推导队列（6% vs 22% vs 77%，P < 0.01）和验证队列（4% vs 30% vs 53%，P < 0.01）中，不同风险组之间的死亡率差异显著。这种死亡评分在确定计划接受诺伍德手术的新生儿的医院死亡风险方面是准确的。该评分有可能在临床实践中用于术前风险评估。临床试验注册网址：http://www.clinicaltrials.gov。唯一标识符：NCT00115934。
