Cao J K, Fan H Q, Xiao Y B, Wang D, Liu C G, Peng X M, Gao X R, Tang S H, Han T, Mei Y B, Liang H Y, Wang S M, Wang F, Li Q P
Department of Neonatology, Senior Department of Pediatrics, the Seventh Medical Center of the People's Liberation Army General Hospital (the Second School of Clinical Medicine, Southern Medical University), Beijing 100700, China.
Department of Cardiology, Hunan Children's Hospital, Changsha 410007, China.
Zhonghua Er Ke Za Zhi. 2024 Feb 2;62(2):129-137. doi: 10.3760/cma.j.cn112140-20230912-00178.
To develop a risk prediction model for identifying bronchopulmonary dysplasia (BPD) associated pulmonary hypertension (PH) in very premature infants. This was a retrospective cohort study. The clinical data of 626 very premature infants whose gestational age <32 weeks and who suffered from BPD were collected from October 1, 2015 to December 31, 2021 of the Seventh Medical Center of the People's Liberation Army General Hospital as a modeling set. The clinical data of 229 very premature infants with BPD of Hunan Children's Hospital from January 1 , 2020 to December 31, 2021 were collected as a validation set for external verification. The very premature infants with BPD were divided into PH group and non PH group based on the echocardiogram after 36 weeks' corrected age in the modeling set and validation set, respectively. Univariate analysis was used to compare the basic clinical characteristics between groups, and collinearity exclusion was carried out between variables. The risk factors of BPD associated PH were further screened out by multivariate Logistic regression, and the risk assessment model was established based on these variables. The receiver operating characteristic (ROC) area under curve (AUC) and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the model's discrimination and calibration power, respectively. And the calibration curve was used to evaluate the accuracy of the model and draw the nomogram. The bootstrap repeated sampling method was used for internal verification. Finally, decision curve analysis (DCA) to evaluate the clinical practicability of the model was used. A total of 626 very premature infants with BPD were included for modeling set, including 85 very premature infants in the PH group and 541 very premature infants in the non PH group. A total of 229 very premature infants with BPD were included for validation set, including 24 very premature infants in the PH group and 205 very premature infants in the non PH group. Univariate analysis of the modeling set found that 22 variables, such as artificial conception, fetal distress, gestational age, birth weight, small for gestational age, 1 minute Apgar score ≤7, antenatal corticosteroids, placental abruption, oligohydramnios, multiple pulmonary surfactant, neonatal respiratory distress syndrome (NRDS)>stage Ⅱ, early pulmonary hypertension, moderate-severe BPD, and hemodynamically significant patent ductus arteriosus (hsPDA) all had statistically significant influence between the PH group and the non PH group (all <0.05). Antenatal corticosteroids, fetal distress, NRDS >stage Ⅱ, hsPDA, pneumonia and days of invasive mechanical ventilation were identified as predictive variables and finally included to establish the Logistic regression model. The AUC of this model was 0.86 (95% 0.82-0.90), the cut-off value was 0.17, the sensitivity was 0.77, and the specificity was 0.84. Hosmer-Lemeshow goodness-of-fit test showed that 0.05. The AUC for external validation was 0.88, and the Hosmer-Lemeshow goodness-of-fit test suggested 0.05. A high sensitivity and specificity risk prediction model of PBD associated PH in very premature infants was established. This predictive model is useful for early clinical identification of infants at high risk of BPD associated PH.
建立一个风险预测模型,用于识别极早产儿支气管肺发育不良(BPD)相关的肺动脉高压(PH)。这是一项回顾性队列研究。将2015年10月1日至2021年12月31日期间解放军总医院第七医学中心收治的626例胎龄<32周且患有BPD的极早产儿的临床资料作为建模集。收集2020年1月1日至2021年12月31日期间湖南省儿童医院229例患有BPD的极早产儿的临床资料作为外部验证的验证集。在建模集和验证集中,分别根据矫正年龄36周后的超声心动图,将患有BPD的极早产儿分为PH组和非PH组。采用单因素分析比较组间基本临床特征,并对变量进行共线性排除。通过多因素Logistic回归进一步筛选出BPD相关PH的危险因素,并基于这些变量建立风险评估模型。采用受试者工作特征(ROC)曲线下面积(AUC)和Hosmer-Lemeshow拟合优度检验分别评估模型的区分能力和校准能力。并使用校准曲线评估模型的准确性并绘制列线图。采用自助重复抽样法进行内部验证。最后,采用决策曲线分析(DCA)评估模型的临床实用性。建模集共纳入626例患有BPD的极早产儿,其中PH组85例,非PH组541例。验证集共纳入229例患有BPD的极早产儿,其中PH组24例,非PH组205例。建模集的单因素分析发现,人工受孕、胎儿窘迫、胎龄、出生体重、小于胎龄儿、1分钟Apgar评分≤7、产前使用糖皮质激素、胎盘早剥、羊水过少、多次使用肺表面活性物质、新生儿呼吸窘迫综合征(NRDS)>Ⅱ期、早期肺动脉高压、中重度BPD、血流动力学显著的动脉导管未闭(hsPDA)等22个变量在PH组和非PH组之间均有统计学意义(均<0.05)。产前使用糖皮质激素、胎儿窘迫、NRDS>Ⅱ期、hsPDA、肺炎和有创机械通气天数被确定为预测变量,最终纳入建立Logistic回归模型。该模型的AUC为0.86(95%CI 0.82 - 0.90),截断值为0.17,灵敏度为0.77,特异度为0.84。Hosmer-Lemeshow拟合优度检验显示P>0.05。外部验证的AUC为0.88,Hosmer-Lemeshow拟合优度检验提示P>0.05。建立了一个高灵敏度和特异度的极早产儿PBD相关PH风险预测模型。该预测模型有助于临床早期识别BPD相关PH的高危婴儿。