Prospective observational cohort study: Computational models for early prediction of ongoing pregnancy in fresh IVF/ICSI‐ET protocols
Prospective observational cohort study: Computational models for early prediction of ongoing pregnancy in fresh IVF/ICSI‐ET protocols
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DOI：
10.1016/j.lfs.2019.03.012
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发表时间：
2019-04
期刊：
影响因子：
6.1
通讯作者：
Huiyu Xu;Yuan Wei;R. Yang;G. Feng;Wenhao Tang;Hongxia Zhang;Yilei He;Ying Feng;Rong Li;J. Qiao
中科院分区：
文献类型：
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作者：
Huiyu Xu;Yuan Wei;R. Yang;G. Feng;Wenhao Tang;Hongxia Zhang;Yilei He;Ying Feng;Rong Li;J. Qiao
本研究旨在找出与持续妊娠(OP)相关的重要因素，并寻找最可靠的模型来区分早期妊娠的OP和非OP。方法共收集1650个 周期。单变量Logistic回归用于确定多变量分析中包含的预测因素。然后将数据集随机分为训练集和测试集，比例分别为70%和30%。采用5次交叉验证的正向逐步多元Logistic回归方法建立最终的数学模型。测试集的参数决定了模型的性能。计算受试者工作特征曲线下面积(AUC)、敏感度、特异度、阳性预测值(PPV)、阴性预测值(NPV)和误分率(MR)进行模型评价。胚胎移植后第14天血清hCG水平(HCG14)与胚胎移植后第21天血清hCG水平(HCG21)呈直线相关。因此，分别用hCG14和hCG21建立了不同的多元回归模型。经5倍检验的多因素回归分析，模型1的最终预测指标为年龄组、hCG21和hCG21/hCG14，模型2的预测指标为年龄组、hCG14和计算的hCG 48h上升率。模型2具有较好的敏感性和净现值，较低的MR，较接近的特异性和PPV。结论本研究为OP的早期预测提供了一个有效的数学模型。该模型可能具有更好的临床意义，特别是对于管理患者的压力和焦虑的临床咨询，以及对先兆流产的早期预警。
PurposeThis study sought to identify the significant factors related to ongoing pregnancy (OP) and to discover the most reliable model to distinguish OP from non-OP in early gestational age.MethodsA total of 1650 cycles were enrolled in this study. Univariate Logistic Regression was used to identify the predictors included in multivariable analysis. The dataset was then randomly split into training set and test set with proportion of 70% and 30%. Forward stepwise multivariable logistic regression with 5-fold cross validation was used to build the final mathematic model. The performance of the model was determined by the arguments of test set. The area under receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and misclassification rate (MR) were then calculated for model evaluation.ResultsSeven predictors were related to OP by univariate analysis. The serum hCG level on 14th day post-embryo-transfer (hCG14) and 21th day post-embryo-transfer (hCG21) were linear correlated. Therefore, different multivariate regression models were built using hCG14or hCG21, respectively. After multivariate regression with 5-fold validation, the final indicators in model-1 were age_group, hCG21and hCG21/hCG14, while age_group, hCG14, and calculated 48-hour-rising-ratio of hCG were the significant predictors in model-2. Model-2 showed better sensitivity and NPV, lower MR, and similar specificity and PPV.ConclusionThis study provided an effective mathematic model for early prediction of OP. The model could be of better clinical significance, especially for clinical counseling to manage patients' stress and anxiety, and for early warning of threatened miscarriage.