Study On The Prediction Model Of Fetal Hydronephrosis For Postnatal Intervention

Objectives To evaluate the diagnostic value of single or multiple factors in predicting postnatal outcome of antenatal hydronephrosis,we analyzed the correlation between the anterior-posterior renal pelvis diameter,the urinary tract dilatation grading system and the outcome of antenatal hydronephrosis.Methods A retrospective analysis was performed on the clinical data of 145 patients with antenatal hydronephrosis who visited the urology department of Shanghai children's hospital from May 2013 to May 2015.96 children included in the study without ureteral dilation,renal malformation and follow-up failure.The clinical data included gender,hydronephrosis laterality,birth weight,birth pregnancy,maternal pregnancy age,birth mode,pregnancy APD value and corresponding UTD grade.The optimal antenatal prediction formula was carried out by Logistic regression analysis with single or multiple factors according to the receiver operating characteristic and the area under the curve.Then a prospective study was performed on the clinical data of 258 patients with antenatal hydronephrosis from 5 Shanghai maternity hospitals.101 children were excluded because of ureteral dilation,renal malformation and follow-up failure.157 children included in this study.Prediction formula obtained from the above study was used to predict the outcome and the results were compared with the actual prognosis.Diagnostic rate,sensitivity,specificity,positive predictive value,negative predictive value and accuracy were compared among 3 group.It's value in predicting the outcome of antenatal hydronephrosis were discussed.Results A total of 145 patients were included in retrospective analysis,including 96 in the conservative group and 35 in the surgical group.There were 35 males(83.3%)in the surgery group,which was higher than 27 males(50%)in the conservative group,and the difference was statistically significant(P=0.001).In the operation group,31patients(73.8%)had left hydronephrosis,which was higher than the 30 patients(55.6%)in the conservative group,and the difference was statistically significant(P=0.001).The area under the curve of gender,laterality,28-34 week APD and?35week APD was 0.667,0.730,0.835 and 0.905 respectively.The prediction formula was y=5.319* sex +3.129* laterality +0.573* APD-14.354.The cutoff value was 0.66,and the AUC was increased to 0.978.A total of 157 patients were enrolled in the prospective study,including 96 in the conservative group and 61 in the surgical group.Gender(female=0,male=1),laterality(left=1,right=0)and APD values of children in ?35 week pregnancy were taken into the prediction formula.Compared with APD=18mm and UTD A2-3grading,the prediction formula was found to have the best prediction effect,with accuracy of 91.08%,sensitivity of 90.16% and specificity of 90.72%.After ROC analysis,AUC was 0.885,and accuracy and AUC were better than that of APD=18mm and UTD A2-3 grade.Conclusions Gender,hydronephrosis laterality,APD value and UTD grade in late pregnancy were all correlated with the outcome of surgery.A multifactor regression prediction formula can be obtained with APD values,gender and laterality.The predictive accuracy and AUC of the predictive formula were better than those of APD=18mm and UTD A2-3 grade.