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预测先天性心脏病新生儿的儿童期长期生存情况:一项基于人群的前瞻性队列研究(EPICARD)。

Predicting Long-Term Childhood Survival of Newborns with Congenital Heart Defects: A Population-Based, Prospective Cohort Study (EPICARD).

作者信息

Rahshenas Makan, Lelong Nathalie, Bonnet Damien, Houyel Lucile, Choodari-Oskooei Babak, Gonen Mithat, Goffinet Francois, Khoshnood Babak

机构信息

Centre of Research in Epidemiology and Statistics (Inserm 1153, CRESS), Université Paris Cité, 75006 Paris, France.

M3C-Necker, National Reference Center for Complex Congenital Heart Diseases, APHP, Université Paris Cité, Hôpital Necker-Enfants Malades, 75015 Paris, France.

出版信息

J Clin Med. 2024 Mar 12;13(6):1623. doi: 10.3390/jcm13061623.

Abstract

Congenital heart defects (CHDs) are the most frequent group of major congenital anomalies, accounting for almost 1% of all births. They comprise a very heterogeneous group of birth defects in terms of their severity, clinical management, epidemiology, and embryologic origins. Taking this heterogeneity into account is an important imperative to provide reliable prognostic information to patients and their caregivers, as well as to compare results between centers or to assess alternative diagnostic and treatment strategies. The Anatomic and Clinical Classification of CHD (ACC-CHD) aims to facilitate both the CHD coding process and data analysis in clinical and epidemiological studies. The objectives of the study were to (1) Describe the long-term childhood survival of newborns with CHD, and (2) Develop and validate predictive models of infant mortality based on the ACC-CHD. This study wasbased on data from a population-based, prospective cohort study: Epidemiological Study of Children with Congenital Heart Defects (EPICARD). The final study population comprised 1881 newborns with CHDs after excluding cases that were associated with chromosomal and other anomalies. Statistical analysis included non-parametric survival analysis and flexible parametric survival models. The predictive performance of models was assessed by Harrell's C index and the Royston-Sauerbrei RD2, with internal validation by bootstrap. The overall 8-year survival rate for newborns with isolated CHDs was 0.96 [0.93-0.95]. There was a substantial difference between the survival rate of the categories of ACC-CHD. The highest and lowest 8-year survival rates were 0.995 [0.989-0.997] and 0.34 [0.21-0.50] for "interatrial communication abnormalities and ventricular septal defects" and "functionally univentricular heart", respectively. Model discrimination, as measured by Harrell's C, was 87% and 89% for the model with ACC-CHD alone and the full model, which included other known predictors of infant mortality, respectively. The predictive performance, as measured by RD2, was 45% and 50% for the ACC-CHD alone and the full model. These measures were essentially the same after internal validation by bootstrap. The ACC-CHD classification provided the basis of a highly discriminant survival model with good predictive ability for the 8-year survival of newborns with CHDs. Prediction of individual outcomes remains an important clinical and statistical challenge.

摘要

先天性心脏病(CHD)是最常见的主要先天性异常类型,占所有出生人口的近1%。就其严重程度、临床管理、流行病学和胚胎学起源而言,它们是一组非常异质性的出生缺陷。考虑到这种异质性对于向患者及其护理人员提供可靠的预后信息,以及在不同中心之间比较结果或评估替代诊断和治疗策略至关重要。先天性心脏病的解剖学和临床分类(ACC-CHD)旨在促进临床和流行病学研究中的CHD编码过程和数据分析。本研究的目的是:(1)描述患有CHD的新生儿的儿童期长期生存率;(2)基于ACC-CHD开发并验证婴儿死亡率的预测模型。本研究基于一项基于人群的前瞻性队列研究的数据:先天性心脏病儿童流行病学研究(EPICARD)。最终研究人群包括1881例患有CHD的新生儿,排除了与染色体和其他异常相关的病例。统计分析包括非参数生存分析和灵活参数生存模型。模型的预测性能通过Harrell's C指数和Royston-Sauerbrei RD2进行评估,并通过自抽样进行内部验证。孤立性CHD新生儿的总体8年生存率为0.96[0.93-0.95]。ACC-CHD各分类的生存率存在显著差异。“房间隔交通异常和室间隔缺损”和“功能性单心室心脏”的最高和最低8年生存率分别为0.995[0.989-0.997]和0.34[0.21-0.50]。仅使用ACC-CHD的模型和包含婴儿死亡率其他已知预测因素的完整模型,通过Harrell's C测量的模型辨别力分别为87%和89%。通过RD2测量的预测性能,仅使用ACC-CHD的模型和完整模型分别为45%和50%。通过自抽样进行内部验证后,这些指标基本相同。ACC-CHD分类为具有高度辨别力的生存模型提供了基础,该模型对患有CHD的新生儿的8年生存率具有良好的预测能力。个体结局的预测仍然是一项重要的临床和统计挑战。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4391/10970958/bf026043280c/jcm-13-01623-g001.jpg

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