Predictive Value of Esophageal Deviation Index for Clinical Outcomes of Patients With Left-Sided Congenital Diaphragmatic Hernia

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2025-02-01 DOI:10.1016/j.jpedsurg.2024.161929

Bo Xia , Qiu-Ming He, Wei Zhong, Jun-Jian Lv, Wen-Hai Fang, Wen-Jie Luo

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Abstract

Purpose

This study aimed to evaluate the prognostic value of postnatal esophageal deviation index (EDI) measured within the first 24 h of life for predicting mortality and morbidity in neonates with left-sided congenital diaphragmatic hernia (L-CDH).

Method

This retrospective study analyzed clinical data from 133 neonates with L-CDH admitted to Guangzhou Women and Children's Medical Center between January 2016 and January 2024. Patients were categorized into two groups based on outcomes: survivors (n = 108) and non-survivors (n = 27). Risk factors for mortality were identified using both univariate and multivariate analyses. A receiver operating characteristic (ROC) curve was utilized to evaluate the predictive value of EDI for mortality in L-CDH patients. Subsequently, patients were divided into two groups: those with an EDI> 16.1% and those with an EDI≤16.1%. The relationship between EDI and both mortality and morbidity was analyzed using Kaplan–Meier analysis, chi-square test, Fisher's exact test, and multivariate analysis.

Results

EDI (adjusted OR: 0.822, 95% CI 0.723–0.935; P = 0.003) was identified as the independent predictor of mortality through both univariate and multivariate logistic regression analysis. The ROC curve demonstrated that the area under the curve (AUC) for predicting the mortality was 0.854 (95%CI: 0.782–0.930) for EDI, with an optimal cut-off value of 16.125%. The cumulative mortality rate through Day 200 was higher in patients with an EDI>16.1% (P＜0.001). Among the 133 neonates with L-CDH, 24.8% had an EDI>16.1%. This was associated with significantly worse CDH characteristics, including a high incidence of intrathoracic stomach and a high occurrence of high-risk defect sizes (type C/D), (P＜0.001), as well as more severe pulmonary hypertension (P＜0.001). An EDI>16.1% was associated with higher mortality and a greater need for ECMO support compared to an EDI≤16.1% (P＜0.001).

Conclusion

EDI within the first 24 h of life in patients with L-CDH is associated with increased mortality and the need for ECMO, particularly when EDI exceeds 16.1%.

Level of Evidence

III.

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食管偏离指数对左侧先天性膈疝患者临床结局的预测价值

目的：本研究旨在评估出生后24小时内测量的食管偏离指数（EDI）预测左侧先天性膈疝（L-CDH）新生儿死亡率和发病率的预后价值：这项回顾性研究分析了广州市妇女儿童医疗中心在2016年1月至2024年1月期间收治的133名左侧先天性膈疝新生儿的临床数据。根据结果将患者分为两组：存活者（108人）和非存活者（27人）。通过单变量和多变量分析确定了死亡率的风险因素。利用接收器操作特征（ROC）曲线评估了 EDI 对 L-CDH 患者死亡率的预测价值。随后，患者被分为两组：EDI>16.1%和EDI≤16.1%。采用卡普兰-梅耶分析、卡方检验、费雪精确检验和多变量分析法分析了EDI与死亡率和发病率之间的关系：通过单变量和多变量逻辑回归分析，EDI（调整后 OR：0.822，95% CI 0.723-0.935；P = 0.003）被确定为死亡率的独立预测因子。ROC 曲线显示，EDI 预测死亡率的曲线下面积（AUC）为 0.854（95%CI：0.782-0.930），最佳临界值为 16.125%。EDI>16.1%的患者在第200天的累积死亡率更高（P＜0.001）。在133名患有L-CDH的新生儿中，24.8%的EDI>16.1%。这与CDH特征明显恶化有关，包括胸内胃发生率高、高风险缺损大小（C/D型）发生率高（P＜0.001）以及更严重的肺动脉高压（P＜0.001）。EDI>16.1%与EDI≤16.1%相比，死亡率更高，更需要ECMO支持（P＜0.001）：结论：L-CDH 患者生命最初 24 小时内的 EDI 与死亡率和 ECMO 需求增加有关，尤其是当 EDI 超过 16.1% 时：证据等级：III。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.