| ObjectiveRisk factors related to severe preeclampsia in hypertensive patients during pregnancy were analyzed and risk prediction scores were constructed to provide evidence for clinical management of severe preeclampsia patients.MethodsThe patients with gestational hypertension and severe preeclampsia who received treatment in a Grade-III Class A general public hospital in Yunnan Province from January 1,2 0 1 9 to June 31,2022 were collected according to the napel criteria.Patients who met the exclusion criteria from January 1,2019 to December 31,2021 were included in the score construction group,and patients from January 1,2022 to June 31,2022 were included in the score verification group.Single factor analysis and multiple Logistic regression were used to screen out independent risk factors in the score construction group.Variable scores were calculated according to the regression coefficientβvalue of each variable,and risk prediction scores were established.Risk stratification was conducted according to the optimal cut-off value of risk prediction score.Score verification was performed with the data from the verification group,and HosmerLemeshow goodness of fit was used to test the fit degree of the risk prediction model.Sensitivity,specificity,Yoden index and area under ROC curve were used to judge the prediction effect of the scale,and the test level was α=0.05.ResultsIn this study,a total of 435 patients who met the criteria for natrification were included.A total of 363 patients were eventually included in the modeling group and 72 in the validation group.And the incidence of severe preeclampsia was 38%.Through univariate analysis,the risk factors were D-dimer(D-D),activated partial thromboplastin time(APTT),uric acid,albumin,platelet(PLT),weight gain,gestational age,and birth time.The number of pregnancies,menstrual parturient women,history of cesarean section,regular birth examination,method of conception,headache,edema,blurred vision,altered state of consciousness,uterine scar,thrombocytopenia,kidney disease and abnormal coagulation function;Multivariate Logistic regression analysis showed that history of cesarean section,headache and dizziness,edema,abnormal uric acid and abnormal coagulation function were independent risk factors for severe preeclampsia in patients with gestational hypertension.Risk prediction score variable scores were constructed according to β value,and the results showed that cesarean section history(3 points),headache and dizziness(2 points),edema(2 points),uric acid(1 point),abnormal coagulation function(2 points),a total of 10 points.The Yoden index was 0.721,the specificity was 0.931,and the sensitivity was 0.79.The optimal cut-off value was determined according to the score corresponding to the Yoden index,and the corresponding score was 6 points,that is,the score <6 was divided into the low-risk group,and the score >6 was divided into the high-risk group.Risk prediction score was evaluated: area under ROC curve was 0.936,standard error was 0.015,95%CI was 0.907～0.964,P<0.001,indicating that the evaluation effect of risk prediction score was good.HosmerLemeshow goodness of fit was used to test the fit degree of the risk prediction model.The results showed that the chi-square value was 6.192 and the P value was 0.626.There was no statistical significance between the actual value and the predicted value,indicating that the risk prediction score had good accuracy.In the verification group,the area under ROC curve was 0.905(95%CI: 0.815-0.995),the positive detection rate was 65%,and the negative detection rate was 96.2%.Hosmer-Lemeshow goodness of fit tested the fit degree of the risk prediction model,and the results showed that the chi-square value was14.513 and the P value was 0.69.There was no statistically significant difference between the actual value and the predicted value,indicating that the risk prediction score also had a good accuracy in the verification group.ConclusionThis study analyzed the risk factors associated with severe preeclampsia by collecting clinical data from patients with gestational hypertension.To construct a risk prediction score for severe preeclampsia in pregnancy-induced hypertension patients,and verify the risk prediction score.(1)Cesarean section history,headache,dizziness,edema,abnormal uric acid,and abnormal coagulation function were independent risk factors for SPE in HDP patients;(2)The early warning score of SPE risk in HDP patients was constructed,and the prediction effect of the risk prediction score on clinical patients was comprehensively verified.The results showed that the prediction effect of the prediction score was good.(3)A simple and fast early risk warning score was constructed to calculate the probability of SPE in HDP patients by easily available indicators,providing a new idea for early clinical intervention in HDP patients and assisting medical staff to make scientific clinical decisions quickly. |
