Establishment And Assessment Of A Nomogram For Predicting Adverse Outcomes Of Preeclampsia

ObjectiveTo determine factors associated with adverse outcomes of preeclampsia before term.To develop and internally validate an accurate prognostic nomogram model to predict the adverse outcomes of preeclampsia before term.MethodsWe developed and internally validated the model in a retrospective study in women who were admitted to our hospital with preeclampsia or who developed preeclampsia after admission.Basic information and medical history characteristics,symptoms and signs,auxiliary examinations and treatment were collected.The pregnant women were divided into two groups according to whether the final adverse outcome occurred: the adverse outcome group(151 cases,44.7%)and the non-adverse outcome group(187 cases,55.3%).In univariate survival analysis of the primary cohort,Kaplan-Meier method was used to plot Survival curves,and the log-rank test to compare differences.Quantitative data were analyzed by univariate COX regression analysis.COX proportional risk model was used for multivariate analysis,and stepwise backward method was used to obtain independent influencing factors.P < 0.05 was considered statistically significant.Then a nomogram created by R software was validated by Bootstrap resampling as internal validation.Concordance index(C-index)was applied to the predictive evaluation of the nomogram and calibration curves were drawn to test the nomogram prediction and actual observation of the adverse outcome rate.Results1.There was no significant difference in mother age,gravidity,parity and body mass index between the two groups(P > 0.05).2.The single factor analysis found that dizziness and headache,abdominal pain,visual impairment,chemosis,convulsions,edema,oligohydramnios and abnormal head Magnetic Resonance Imaging(MRI)result,abnormal random urine protein,White Blood Cell Count(WBC),Platelet Count,(PLT),Fibrinogen Degradation Products(FDP)and Fibrinogen(Fib),Uric Acid(UA),Alanine ammonia(ALT),Aspartate Aminotransferase(AST),plasma Albumin(ALB),Total Bile Acid(TBA),triglycerides(TG),Lactate Dehydrogenase(LDH),Blood Urea Nitrogen(BUN),Creatinine(Cr),urinary protein quantification,maximum systolic Blood pressure and maximum diastolic Blood pressure were all influence factors for adverse outcomes.3.In multivariate analysis,chemosis,oligohydramnios,maximum systolic blood pressure,antihypertensive therapy,WBC,PLT,platelet distribution width(PDW),red blood cell distribution width(RDWCV),prothrombin time(PT),FDP?Fib? UA?ALB had been identified as independent prognostic factors.After 1000 internal validation of Bootstrap resampling,The C-index of the nomogram for predicting adverse outcome within 48 hours was 0.74(95% CI,0.70-0.78),Cut-off value was 0.53,with a sensitivity of 61.57% and a specificity of 76.93%.The C-index of the nomogram for predicting adverse outcome within 7 days was 0.76(95% CI,0.71-0.81),Cut-off value was 0.37,with a sensitivity of 58.17% and a specificity of 84.82%.Good concordance of Incidence of adverse outcome between nomogram prediction and actual observation was shown by the calibration curves.ConclusionIn this study,COX regression was used to establish a nomogram model to predict adverse outcomes in pregnant women with pre-eclampsia before full term within 48 hours and 7 days,so as to evaluate the probability of adverse outcomes individually.This model has certain guiding significance in preventing and treating adverse outcomes,choosing the time of termination of pregnancy and improving the prognosis of mother and child.