Prediction and prognosis of adverse maternal and foetal/neonatal outcomes in pulmonary hypertension: an observational study and nomogram construction.
Prediction and prognosis of adverse maternal and foetal/neonatal outcomes in pulmonary hypertension: an observational study and nomogram construction.
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肺动脉高压孕产妇和胎儿/新生儿不良结局的预测和预后：观察性研究和列线图构建
DOI：
10.1186/s12931-022-02235-y
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发表时间：
2022-11-15
影响因子：
5.8
通讯作者：
中科院分区：
文献类型：
--
作者：
患有肺动脉高压（PH）的孕妇死亡率较高，胎儿/新生儿结局较差。评估这些风险因素的工具尚未完善。使用 2009 年 1 月至 2018 年 12 月期间记录的 420 名妊娠 PH 患者的“发展”队列数据构建了预测和预后列线图。逻辑回归分析建立了模型，通过 Cox 分析预测不良孕产妇和胎儿/新生儿事件的概率以及总体生存率。独立的“验证”队列包含 2019 年 1 月至 2022 年 5 月期间评估的 273 名连续患者的数据。列线图性能经过内部评估，并通过在线软件实施，以提高易用性。 I 型呼吸衰竭、纽约心脏协会功能分级、N 端脑钠肽前体 1400 ng/L、心律失常和子痫伴既存高血压是孕产妇死亡或心力衰竭的独立危险因素。 I 型呼吸衰竭、心律失常、剖腹产全身麻醉、纽约心脏协会功能分级和 N 末端脑钠肽前体 1400 ng/L 是妊娠期间肺动脉高压生存的独立预测因素。对于胎儿/新生儿不良临床事件，I型呼吸衰竭、心律失常、剖腹产全身麻醉、产次、血小板计数、纤维蛋白原和左心室收缩直径是重要的预测因素。开发和验证队列的列线图应用显示出良好的区分和校准；决策曲线分析证明了其临床实用性。列线图及其在线软件可用于分析个体死亡率、心力衰竭风险、总体生存预测和不良胎儿/新生儿临床事件，这可能有助于促进早期干预和提高生存率。在线版本包含可在 10.1186/s12931-022-02235-y 获取的补充材料。
Pregnant women with pulmonary hypertension (PH) have higher mortality rates and poor foetal/neonatal outcomes. Tools to assess these risk factors are not well established. Predictive and prognostic nomograms were constructed using data from a “Development” cohort of 420 pregnant patients with PH, recorded between January 2009 and December 2018. Logistic regression analysis established models to predict the probability of adverse maternal and foetal/neonatal events and overall survival by Cox analysis. An independent “Validation” cohort comprised data of 273 consecutive patients assessed from January 2019 until May 2022. Nomogram performance was evaluated internally and implemented with online software to increase the ease of use. Type I respiratory failure, New York Heart Association functional class, N-terminal pro-brain natriuretic peptide 1400 ng/L, arrhythmia, and eclampsia with pre-existing hypertension were independent risk factors for maternal mortality or heart failure. Type I respiratory failure, arrhythmia, general anaesthesia for caesarean section, New York Heart Association functional class, and N-terminal pro-brain natriuretic peptide 1400 ng/L were independent predictors of pulmonary hypertension survival during pregnancy. For foetal/neonatal adverse clinical events, type I respiratory failure, arrhythmia, general anaesthesia for caesarean section, parity, platelet count, fibrinogen, and left ventricular systolic diameter were important predictors. Nomogram application for the Development and Validation cohorts showed good discrimination and calibration; decision curve analysis demonstrated their clinical utility. The nomogram and its online software can be used to analyse individual mortality, heart failure risk, overall survival prediction, and adverse foetal/neonatal clinical events, which may be useful to facilitate early intervention and better survival rates. The online version contains supplementary material available at 10.1186/s12931-022-02235-y.
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2.8
作者：
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