| Objective:To establish a predictive model based on clinical characteristics and systemic immune-inflammation parameters,and determine the value for histological chorioamnionitis among women with preterm premature rupture of membranes(PPROM).Methods:204 spontaneous PPROM pregnant women without pregnancy complications who were delivered in the obstetrics department of the Women&Children’s Hospital,School of Medicine,Xiamen University from June 2013 to December 2018 were collected by the Hospital Information System(HIS).The pregnant women were categorized into the following two groups according to placental examination:The control group was 113 cases without histological chorioamnionitis and the case group was 91 cases with histological chorioamnionitis.Patients’ clinical information were collected,including maternal age,gravidity and parity,history of preterm birth,educational level,living environment,temperature,the gestational age at the rupture of membranes,duration of the rupture of membranes(from admission to delivery),blood routine examination at admission(including the maternal serum white blood cell(WBC),neutrophil%(NEU%),neutrophil count(NEU),lym phocyte count(LYM),platelet(PLT),Hemoglobin(HGB),Cell distribution width(RDW)),CRP,pregnancy outcomes and calculate the NLR(neutrophils/lymphocyte ratio),PLR(platelet/lymphocyte ratio),and SII.Univariate analysis was performed on the clinical data.Then multivariate logistic regression analysis was conducted for risk factors with statistical differences.The logistic regression model was established,thus,a model was calculated by multivariate analysis was obtained,by the way,the receiver operating characteristic curve was used to examine the discrimination of the predictive model,the Hosmer-Lemeshow test verified its calibration to evaluate the predictive model.Results:(1)There were no differences in maternal age,gravidity and parity,history of preterm birth,educational level,living environment,temperature and duration of the rupture of membranes between the two groups(P>0.05).Pregnancy outcomes such as neonatal weight,1 minute,5 minute and 10 minute Apgar score,the days the neonate stay in hospital and gestation week at delivery act.in the case group were significantly different from those in the control group,P<0.05.(2)Gestation age at the rupture of membranes in the case group was 33.9(32.7-35.1)weeks,while this in the control group was 34.7(33.8-35.6)weeks,The difference was significant,P<0.05.Mmaternal serum WBC,NEU%,NEU,LYM,NLR,CRP,PLR and SII were different between the two groups,the differences were statistically significant(P<0.05).(3)Multivariate analysis revealed that the gestation age at the rupture of membranes,maternal serum NLR and CRP were independent risk factors for PPROM with HCA(P<0.05).A predictive equation was formed as follow:Logit(P)=In(P/1-P)=6.086+0.077 × CRP+0.214 × NLR-0.227 × the gestation age;P=1/1+exp(-6.086-0.077 × CRP-0.214 × NLR+0.227 × the gestation age).When the cut-off value was 0.35 according to Youden index,the accuracy,sensitivity,specificity,positive predictive value and negative predictive value of the predictive model was 62%,79.1%,47.8%,55.38%and 73.97%,The ROC curve was established by the predictive model’s probabilities.The area under the curve was 0.702,indicating that the model had good discrimination and good diagnostic results.The Hosmer-Lemeshow test showed that the model had better calibration ability.Conclusion:(1)PPROM with HCA has a significant impact on pregnancy outcome,including the earlier gestational age at delivery,the lower neonatal weight and Apgar score,and the longer hospitalization days for newborns.Therefore,early warning of HCA should be paid attention to.(2)An effective predictive model for the combination of maternal serum NLR,CRP and the gestation age at the rupture of membranes maybe helpful for prediction and early diagnostic assessment of preterm premature rupture of membranes with histological chorioamnionitis. |
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