Du Yang, Yuan Lin, Zhou Jian-Guo, Huang Xiang-Yuan, Lin Sam Bill, Yuan Meng, He Yue, Mao Wei-Ying, Ai Dan-Yang, Chen Chao
Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.
Department of Clinical Epidemiology, Children's Hospital of Fudan University, Shanghai, China.
Transl Pediatr. 2021 Jan;10(1):73-82. doi: 10.21037/tp-20-192.
Echocardiography has poor accuracy in grading the severity of pulmonary hypertension (PH) compared to cardiac catheterization. However, the relationship between degree of PH and prognostic outcomes remains uncertain. Our primary objective was to determine whether echocardiogram-assessed PH severity is associated with mortality and hospital readmission in the first year of life.
A retrospective cohort study of infants born less than 32 weeks of gestational age with bronchopulmonary dysplasia (BPD) underwent echocardiography was performed. Echocardiograms were performed at 36-38 weeks postmenstrual age. Data during hospitalization and post-discharge collected at 1-year age were analyzed with cox regression models and logistic regression models to identify the association of PH severity with mortality and readmission. Area under curve (AUC) was calculated to examine the accuracy of these models to reflect the likelihood of outcomes.
Fifty-six of 237 (23.6%) infants were diagnosed as PH. Moderate and severe PH was significantly associated with mortality during the first one year of life (moderate PH . none HR =26.58, 95% CI: 4.40-160.78, P<0.001; severe PH . none HR =36.49, 95% CI: 5.65-235.84, P<0.001). Male, preeclampsia and inhaled nitric oxide were also associated with mortality. Mild PH was significantly associated with readmission (OR =2.42, 95% CI: 1.12-5.26, P=0.025), but not associated with mortality (HR =2.09, 95% CI: 0.43-10.18, P=0.36). The PH severity model based on echocardiography accurately informed mortality (AUC 0.79).
Echocardiogram-assessed PH severity is associated with prognostic outcomes, including mortality and readmission in very preterm infants with BPD. The severity of PH based on echocardiography is a potential predictor of mortality in the first year of life.
与心导管检查相比，超声心动图在评估肺动脉高压（PH）的严重程度方面准确性较差。然而，PH程度与预后结果之间的关系仍不确定。我们的主要目的是确定超声心动图评估的PH严重程度是否与生命第一年的死亡率和再入院率相关。
对出生时胎龄小于32周且患有支气管肺发育不良（BPD）并接受超声心动图检查的婴儿进行了一项回顾性队列研究。在月经龄36 - 38周时进行超声心动图检查。使用Cox回归模型和逻辑回归模型分析1岁时收集的住院期间和出院后的数据，以确定PH严重程度与死亡率和再入院率之间的关联。计算曲线下面积（AUC）以检验这些模型反映结果可能性的准确性。
237名婴儿中有56名（23.6%）被诊断为PH。中度和重度PH与生命的第一年死亡率显著相关（中度PH.无PH HR = 26.58，95% CI：4.40 - 160.78，P < 0.001；重度PH.无PH HR = 36.49，95% CI：5.65 - 235.84，P < 0.001）。男性、先兆子痫和吸入一氧化氮也与死亡率相关。轻度PH与再入院率显著相关（OR = 2.42，95% CI：1.12 - 5.
