Clinical Characteristics And Predictive Models For Adverse Outcomes With Early And Late Onset Preeclampsia

Objective:To compare and ananlyze the clinical characteristics in patients with early and late onset preeclampsia;and to determine the factors associated with adverse outcomes of two preeclampsia subtypes and develop a predictive mode1.Methods: Totally 460 clinical case were collected from patients with preeclampsia admitted to the Second hospital of Lanzhou University from 2011 to 2019.According to the gestational age(by 34 weeks),the pationts were divide into two groups,including 114 early onset preeclampsia(including 46 with adverse outcome and 68 without adverse outcome)and 346 with late onset preeclampsia(including 54 with adverse outcome and 292 without adverse outcome).The maternal characteristics,clinical symptoms,clinical test indicators and perinatal outcomes were compared between the two groups.Factors associated with adverse outcomes of early and late onset groups were identified though univariate analysis.The statistically significant factors of univariate analysis were included in multivariate logistic regression analysis,and early warning models of early and late onset preeclampsia adverse outcomes were established.Results:(1)Comparison of clinical characteristics between early onset and late onset preeclampsia.Compared with late-onset preeclampsia group,there was a significant decrease in ratio of primipara,regular prenatal examination,high education(p<0.05);and the incidence of blurred vision,edema,headache or dizziness,chest pain or dyspnea,nausea and vomiting,strongly positive protein,notch of uterine artery were higher(p<0.05).PLT and ALB in early preeclampsia group were significantly lower(p<0.05);and D-dimer,CR,UA,BUN,ALT,AST,CHO,LDL,24-hour urine protein and uterus arterial RI was significantly higher than that in the late-onset preeclampsia group(p<0.05).(2)Analysis of risk factors for early outcomes of early onset preeclampsia.The results univariate logistic regression analysis showed neuropsychiatric disease,headache or dizziness,chest pain or dyspnea,D-dimer,UA,AST,24-hour urine protein,left uterine artery RI,notch of left uterine artery,right uterine artery RI,notch of the right uterine artery,and the umbilical blood flow S/D value,living in the city,the number of prenatal examination,gestational week,RBC,HB,PLT,TG,LD,and education are associated with adverse outcomes of early onset preeclampsia.The results multivariate analysis showed that chest pain or dyspnea,high levels of UA,and notch of left uterine artery were risk factors for early pregnancy outcomes in early preeclampsia.high levels of PLT and high education level are protective factors for adverse outcomes of early onset preeclampsia.Logistic regression model: LogitP=-4.125+2.106 Chest pain or dyspnea+0.008UA-0.011PLT+12.098 notch for left uterine artery-0.741 level of education.The AUC of this model is 0.804.when the prediction is 0.697,the Yoden index is 0.533,with the specificity and sensitivity of 68.3.4% and 85%.(3)Analysis of risk factors for early outcomes of last onset preeclampsia.The results univariate logistic analysis showed CVD,neuropsychiatric disease,blurred vision,headache,chest pain or dyspnea,nausea and vomiting,blood pressure at admission,urine protein,D-dimer,UA,ALT,AST 24-hour urine protein,left uterine artery RI,notch of left uterine artery,right uterine artery RI,notch of right uterine artery,umbilical blood flow S/D,Age,Han nationality,place of residence,number of prenatal examination,RBC,HB,PLT,ALB,and level of education are associated with adverse outcomes of last onset preeclampsia.The results multivariate analysis showed that CVD,chest pain or dyspnea,nausea and vomiting,high levels of UA,high levels of right uterine artery RI value were risk factors for adverse outcomes of late onset eclampsia.Logistic regression model: LogitP=-2.324+ 2.227 CVD +2.135 chest pain or dyspnea + 0.008UA+3.327 nausea and vomiting+2.163 right uterine artery RI.The AUC of this model is 0.901.When the prediction is 0.891,the Yoden index is 0.667,with the specificity and sensitivity of 78.4% and 88.2%.Conclusion: There are significant differences in maternal characteristics,clinical symptoms,test indicators and pregnancy outcome in early-onset preeclampsia and lateonset preeclampsia.Chest pain or dyspnea,high levels of UA,notch of left uterine artery are risk factors for adverse outcomes in early preeclampsia,high level of education,high levels of PLT are protective factors.Risk factors for adverse outcomes in late-onset preeclampsia are cardiovascular diseases,chest pain or dyspnea,nausea and vomiting,high levels of UA,high levels of right uterine artery RI value.