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

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

doi:10.1016/j.jpedsurg.2024.161929

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

J Pediatr Surg. 2024 Sep 20:161929. doi: 10.1016/j.jpedsurg.2024.161929. Online ahead of print.

Authors

Bo Xia¹, Qiu-Ming He², Wei Zhong³, Jun-Jian Lv⁴, Wen-Hai Fang⁵, Wen-Jie Luo⁶

Affiliations

¹ Department of Neonatal Surgery Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong Province, China. Electronic address: 124684744@qq.com.
² Department of Neonatal Surgery Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong Province, China. Electronic address: qiuminghe@foxmail.com.
³ Department of Neonatal Surgery Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong Province, China. Electronic address: manr68@126.com.
⁴ Department of Neonatal Surgery Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong Province, China. Electronic address: 13538787151@163.com.
⁵ Department of Neonatal Surgery Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong Province, China. Electronic address: 13060583644@163.com.
⁶ Department of Neonatal Surgery Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong Province, China. Electronic address: 17896639654@163.com.

PMID: 39389878
DOI: 10.1016/j.jpedsurg.2024.161929

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.

Keywords: Congenital diaphragmatic hernia; Esophageal deviation index; Mortality.