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A novel congenital diaphragmatic hernia prediction model for Chinese subjects: A multicenter cohort investigation
1Department of Fetal Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China.
Insights
A new Chinese Congenital Diaphragmatic Hernia (CCDH) score effectively predicts survival outcomes in infants with congenital diaphragmatic hernia. This model demonstrates superior suitability for the Chinese population compared to the existing Brindle score.
Area of Science:
- Pediatric Surgery
- Neonatology
- Medical Informatics
Background:
- Congenital diaphragmatic hernia (CDH) is a severe condition requiring accurate prognostication.
- The Brindle score was developed to stratify CDH severity but its applicability in diverse populations is uncertain.
Purpose of the Study:
- To develop a novel predictive model for CDH outcomes in Chinese infants.
- To externally validate the existing Brindle score in the Chinese population.
Main Methods:
- A least absolute shrinkage and selection operator regression was used for factor screening.
- Internal validation was performed using bootstrap resampling.
- Model performance was assessed using C-index and area under the receiver operating characteristic curve.
Main Results:
- The developed Chinese Congenital Diaphragmatic Hernia (CCDH) score includes pulmonary hypertension, low 5-min Apgar score, chromosomal anomaly, major cardiac anomalies, lung-to-head ratio, and liver herniation.
- The CCDH score demonstrated excellent predictive ability (C-index=0.941).
- The Brindle score showed fair predictive power (AUC=0.820-0.881) but was less suitable than the CCDH score for Chinese patients.
Conclusions:
- The CCDH score is the first predictive model tailored to the Chinese population for congenital diaphragmatic hernia.
- The CCDH score accurately predicts survival outcomes in Chinese infants with CDH.
Purpose Of The Study:
Brindle et al. (2014) and the Congenital Diaphragmatic Hernia Study Group constructed a simplified clinical prediction rule (Brindle score) to stratify infants with congenital diaphragmatic hernia based on disease severity. We aimed to develop a predictive model applicable to Chinese patients with congenital diaphragmatic hernia and externally validate whether the Brindle score is applicable to the Chinese population.
Patients And The Methods:
Multiple imputations supplemented the missing data. A least absolute shrinkage and selection operator regression was used to screen the factors influencing adverse outcomes. Internal validation was performed by bootstrap resampling. The C-index, area under the receiver operating characteristic curve, and the Hosmer-Lemeshow test evaluated the predictive power.
Results:
A nomogram named "CCDH score" (Chinese Congenital Diaphragmatic Hernia score), including pulmonary hypertension, low 5-min Apgar score (<7), chromosomal anomaly, major cardiac anomalies (MCAs), observed-to-expected lung-to-head ratio, and the percentage of liver herniation, was constructed. The CCDH score revealed good calibration and discriminative abilities, with a C-index of 0.941. In the training and external validation cohorts, the area under the receiver operating characteristic curve of the Brindle score were 0.820 and 0.881, respectively. The Brindle score has fair predictive power in the Chinese population, but the newly established CCDH score seems more suitable for Chinese patients with congenital diaphragmatic hernia.
Conclusion:
The CCDH score is the first predictive model constructed based on the characteristics of the Chinese population and can accurately predict the survival outcomes of patients with congenital diaphragmatic hernia.
