使用SNAP-II评分预测先天性膈疝新生儿的体外膜肺氧合及死亡率

Prediction of ECMO and Mortality in Neonates with Congenital Diaphragmatic Hernia Using the SNAP-II Score.

作者信息

Kipfmueller Florian, Schroeder Lukas, Melaku Tamene, Geipel Annegret, Berg Christoph, Gembruch Ulrich, Heydweiller Andreas, Bendixen Charlotte, Reutter Heiko, Müller Andreas

机构信息

Department of Neonatology and Pediatric Critical Care Medicine, University Children's Hospital, Bonn, Germany.

Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Germany.

出版信息

Klin Padiatr. 2019 Nov;231(6):297-303. doi: 10.1055/a-1009-6671. Epub 2019 Sep 30.

DOI:10.1055/a-1009-6671

PMID:31569261

Abstract

BACKGROUND

The mortality of neonates with congenital diaphragmatic hernia (CDH) ranges between 20 and 40% even in specialized high-volume centers. The Score for Neonatal Acute Physiology-II (SNAP-II Score) could facilitate the decision about supportive therapies in CDH newborns.

METHODS

The SNAP-II score consists of the variables arterial blood pressure, pH, PaO:FiO, body temperature, diuresis, and seizure activity and was calculated at an age of 12 h.

RESULTS

101 CDH newborns treated in our institution between 2009 and 2017 were included in the study. A SNAP-II score ≥ 28 was calculated as cutoff for predicting mortality (AUC 0.876; 95% CI: 0.795-0.957). The mortality rate was 52.9% with a SNAP-II score ≥ 28, and 5.9% with a SNAP-II score<28. Sensitivity and specificity for predicting mortality was 81.8 and 79.7%, the negative predicting value (NPV) was 94.0%, the positive predicting value (PPV) 52.9%. The optimal cutoff for predicting ECMO was ≥ 22 (AUC 0.895; 95% CI: 0.836-0.954). Sensitivity and specificity for predicting ECMO therapy was 90.7, and 63.8%, the NPV was 90.2%, and the PPV was 65% respectively. The SNAP-II score was independently associated with mortality [OR 1.126 (95% CI: 1.050-1.207)] and the need for ECMO therapy [OR 1.243 (95% CI: 1.106-1.397)].

CONCLUSION

The SNAP-II score is strongly associated with mortality and the need for ECMO therapy in CDH newborns and should be implemented in the risk stratification of these infants.

摘要

背景

即使在高容量的专业中心，先天性膈疝（CDH）新生儿的死亡率也在20%至40%之间。新生儿急性生理学评分-II（SNAP-II评分）有助于决定对CDH新生儿的支持治疗。

方法

SNAP-II评分由动脉血压、pH值、动脉血氧分压与吸入氧浓度比值、体温、尿量和癫痫活动等变量组成，在12小时龄时计算。

结果

本研究纳入了2009年至2017年在我院接受治疗的101例CDH新生儿。计算得出SNAP-II评分≥28作为预测死亡率的临界值（曲线下面积0.876；95%置信区间：0.795-0.957）。SNAP-II评分≥28时死亡率为52.9%，评分<28时死亡率为5.9%。预测死亡率的敏感性和特异性分别为81.8%和79.7%，阴性预测值（NPV）为94.0%，阳性预测值（PPV）为52.9%。预测体外膜肺氧合（ECMO）的最佳临界值为≥22（曲线下面积0.895；95%置信区间：0.836-0.954）。预测ECMO治疗的敏感性和特异性分别为90.7%和63.8%，NPV为90.2%，PPV为65%。SNAP-II评分与死亡率[比值比1.126（95%置信区间：1.050-1.207）]和ECMO治疗需求[比值比1.243（95%置信区间：1.106-1.397）]独立相关。