Risk Score for Predicting Treatment-Requiring Retinopathy of Prematurity (ROP) in the Telemedicine Approaches to Evaluating Acute-Phase ROP Study

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• 作者：Gui-shuang Ying ; PhD¹ ; ^{gsying@mail.med.upenn.edu" class="auth_mail" title="E-mail the corresponding author} ; Deborah VanderVeen ; MD² ; Ebenezer Daniel ; MBBS ; PhD¹ ; Graham E. Quinn ; MD ; MSCE³ ; Agnieshka Baumritter ; MS³ ; for the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity Cooperative Group^&lowast ;
• 关键词：AUC ; area under receiver operating characteristic curve ; BW ; birth weight ; CI ; confidence interval ; e-ROP ; Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity ; GA ; gestational age ; OR ; odds ratio ; PMA ; postmenstrual age ; ROP ; retinopathy of prematurity ; RW-ROP ; referral-warranted retinopathy of prematurity ; TR-ROP ; treatment-requiring retinopathy of prematurity
• 刊名：Ophthalmology
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：123
• 期：10
• 页码：2176-2182
• 全文大小：298 K

文摘

To develop a risk score for predicting treatment-requiring retinopathy of prematurity (TR-ROP) in the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity (e-ROP) study.

Design

Second analyses of an observational cohort study.

Participants

Infants with birth weight (BW) <1251 g who had ≥1 imaging session by 34 weeks of postmenstrual age (PMA) and ≥1 subsequent retinopathy of prematurity (ROP) examination for determining TR-ROP by study-certified ophthalmologists.

Methods

Nonphysician trained readers evaluated wide-field retinal image sets for characteristics of ROP, pre-plus/plus disease, and retinal hemorrhage. Risk score points for predicting TR-ROP were derived from the regression coefficients of significant predictors in a multivariate logistic regression model.

Main Outcome Measures

TR-ROP.

Results

Eighty-five of 771 infants (11.0%) developed TR-ROP. In a multivariate model, significant predictors for TR-ROP were gestational age (GA) (odds ratio [OR], 5.7; 95% confidence interval [CI], 1.7–18.9 for ≤25 vs. ≥28 weeks), need for respiratory support (OR, 7.0; 95% CI, 1.3–37.1 for high-frequency oscillatory ventilation vs. no respiratory support), slow weight gain (OR, 2.4; 95% CI, 1.2–4.6 for weight gain ≤12 g/day vs. >15 g/day), and image findings at the first image session including number of quadrants with pre-plus (OR, 3.8; 95% CI, 1.5–9.7 for 4 pre-plus quadrants vs. no pre-plus), stage and zone of ROP (OR, 4.7; 95% CI, 2.1–11.8 for stage 1–2 zone I, OR, 5.9; 95% CI, 2.1–16.6 for stage 3 zone I vs. no ROP), and presence of blot hemorrhage (OR, 3.1; 95% CI, 1.4–6.7). Image findings predicted TR-ROP better than GA (area under receiver operating characteristic curve [AUC] = 0.82 vs. 0.75, P = 0.03). The risk of TR-ROP steadily increased with higher risk score and predicted TR-ROP well (AUC = 0.88; 95% CI, 0.85–0.92). Risk score ≥3 points for predicting TR-ROP had a sensitivity of 98.8%, specificity of 40.1%, and positive and negative predictive values of 17.0% and 99.6%, respectively.

Conclusions

Image characteristics at 34 PMA weeks or earlier independently predict TR-ROP. If externally validated in other infants, risk score, calculated from image findings, GA, weight gain, and respiratory support, enables early identification of infants in need of increased surveillance for TR-ROP.