开发和验证预测前置胎盘剖宫产妇女严重产后出血的列线图：一项多中心回顾性病例对照研究
Developing and Validating Nomogram to Predict Severe Postpartum Hemorrhage in Women With Placenta Previa Undergoing Cesarean Delivery: A Multicenter Retrospective Case-Control Study.
作者信息
Dang Xiaohe, Zhang Li, Bao Yindi, Xu Jie, Du Hui, Wang Shaoshuai, Liu Yanyan, Deng Dongrui, Chen Suhua, Zeng Wanjiang, Feng Ling, Liu Haiyi
机构信息
Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Obstetrics and Gynecology, The Central Hospital of Wuhan, Wuhan, China.
出版信息
Front Med (Lausanne). 2022 Feb 11;8:789529. doi: 10.3389/fmed.2021.789529. eCollection 2021.
OBJECTIVE
Developing and validating nomogram to predict severe postpartum hemorrhage (SPPH) in women with placenta previa (PP) undergoing cesarean delivery.
METHODS
We conducted a multicenter retrospective case-control study in five hospitals. In this study, 865 patients from January, 2018 to June, 2020 were enrolled in the development cohort, and 307 patients from July, 2020 to June, 2021 were enrolled in the validation cohort. Independent risk factors for SPPH were obtained by using the multivariate logistic regression, and preoperative nomogram and intraoperative nomogram were developed, respectively. We compared the discrimination, calibration, and net benefit of the two nomograms in the development cohort and validation cohort. Then, we tested whether the intraoperative nomogram could be used before operation.
RESULTS
There were 204 patients (23.58%) in development cohort and 80 patients (26.06%) in validation cohort experienced SPPH. In development cohort, the areas under the receiver operating characteristic (ROC) curve (AUC) of the preoperative nomogram and intraoperative nomogram were 0.831 (95% , 0.804, 0.855) and 0.880 (95% , 0.854, 0.905), respectively. In validation cohort, the AUC of the preoperative nomogram and intraoperative nomogram were 0.825 (95% , 0.772, 0.877) and 0.853 (95% , 0.808, 0.898), respectively. In the validation cohort, the AUC was 0.839 (95% CI, 0.789, 0.888) when the intraoperative nomogram was used before operation.
CONCLUSION
We developed the preoperative nomogram and intraoperative nomogram to predict the risk of SPPH in women with PP undergoing cesarean delivery. By comparing the discrimination, calibration, and net benefit of the two nomograms in the development cohort and validation cohort, we think that the intraoperative nomogram performed better. Moreover, application of the intraoperative nomogram before operation can still achieve good prediction effect, which can be improved if the severity of placenta accreta spectrum (PAS) can be accurately distinguished preoperatively. We expect to conduct further prospective external validation studies on the intraoperative nomogram to evaluate its application value.
目的
开发并验证用于预测行剖宫产术的前置胎盘（PP）女性严重产后出血（SPPH）的列线图。
方法
我们在五家医院开展了一项多中心回顾性病例对照研究。本研究中，2018年1月至2020年6月的865例患者纳入开发队列，2020年7月至2021年6月的307例患者纳入验证队列。通过多因素逻辑回归获得SPPH的独立危险因素，并分别绘制术前列线图和术中列线图。我们比较了两个列线图在开发队列和验证队列中的区分度、校准度和净效益。然后，我们测试了术中列线图是否可在术前使用。
结果
开发队列中有204例患者（23.58%）发生SPPH，验证队列中有80例患者（26.06%）发生SPPH。在开发队列中，术前列线图和术中列线图的受试者操作特征（ROC）曲线下面积（AUC）分别为0.831（95% ，0.804，0.855）和0.880（95% ，0.854，0.905）。在验证队列中，术前列线图和术中列线图的AUC分别为0.825（95% ，0.772，0.877）和0.853（95% ，0.808，0.898）。在验证队列中，术前使用术中列线图时AUC为0.839（95%CI，0.789，0.888）。
结论
我们开发了术前列线图和术中列线图来预测行剖宫产术的PP女性发生SPPH的风险。通过比较两个列线图在开发队列和验证队列中的区分度、校准度和净效益，我们认为术中列线图表现更好。此外，术前使用术中列线图仍可获得良好的预测效果，如果术前能准确区分胎盘植入谱系（PAS）的严重程度，预测效果可能会得到改善。我们期望对术中列线图进行进一步的前瞻性外部验证研究，以评估其应用价值。
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