Development and Validation of Nomograms to Predict Clinical Outcomes of Preeclampsia

Overview

Journal Front Endocrinol (Lausanne)

Specialty Endocrinology

Date 2024 Mar 29

PMID 38549768

Authors

Yan Xia

Yao Wang

Shijin Yuan

Jiaming Hu

Lu Zhang

Jiamin Xie

Yang Zhao

Jiahui Hao

Yanwei Ren

Shengjun Wu

Affiliations

Soon will be listed here.

Abstract

Background: Preeclampsia (PE) is one of the most severe pregnancy-related diseases; however, there is still a lack of reliable biomarkers. In this study, we aimed to develop models for predicting early-onset PE, severe PE, and the gestation duration of patients with PE.

Methods: Eligible patients with PE were enrolled and divided into a training ( = 253) and a validation ( = 108) cohort. Multivariate logistic and Cox models were used to identify factors associated with early-onset PE, severe PE, and the gestation duration of patients with PE. Based on significant factors, nomograms were developed and evaluated using the area under the curve (AUC) and a calibration curve.

Results: In the training cohort, multiple gravidity experience ( = 0.005), lower albumin (ALB; < 0.001), and higher lactate dehydrogenase (LDH; < 0.001) were significantly associated with early-onset PE. Abortion history ( = 0.017), prolonged thrombin time (TT; < 0.001), and higher aspartate aminotransferase ( = 0.002) and LDH ( = 0.003) were significantly associated with severe PE. Abortion history ( < 0.001), gemellary pregnancy ( < 0.001), prolonged TT ( < 0.001), higher mean platelet volume ( = 0.014) and LDH ( < 0.001), and lower ALB ( < 0.001) were significantly associated with shorter gestation duration. Three nomograms were developed and validated to predict the probability of early-onset PE, severe PE, and delivery time for each patient with PE. The AUC showed good predictive performance, and the calibration curve and decision curve analysis demonstrated clinical practicability.

Conclusion: Based on the clinical features and peripheral blood laboratory indicators, we identified significant factors and developed models to predict early-onset PE, severe PE, and the gestation duration of pregnant women with PE, which could help clinicians assess the clinical outcomes early and design appropriate strategies for patients.

References

Kohli S, Ranjan S, Hoffmann J, Kashif M, Daniel E, Al-Dabet M . Maternal extracellular vesicles and platelets promote preeclampsia via inflammasome activation in trophoblasts. Blood. 2016; 128(17):2153-2164. DOI: 10.1182/blood-2016-03-705434. View

Wang Z, Zhao G, Zeng M, Feng W, Liu J . Overview of extracellular vesicles in the pathogenesis of preeclampsia†. Biol Reprod. 2021; 105(1):32-39. DOI: 10.1093/biolre/ioab060. View

Hosseini A, Dolati S, Hashemi V, Abdollahpour-Alitappeh M, Yousefi M . Regulatory T and T helper 17 cells: Their roles in preeclampsia. J Cell Physiol. 2018; 233(9):6561-6573. DOI: 10.1002/jcp.26604. View

. ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2018; 133(1):1. DOI: 10.1097/AOG.0000000000003018. View

Karehed K, Wikstrom A, Olsson A, Larsson A, Olovsson M, Akerud H . Fibrinogen and histidine-rich glycoprotein in early-onset preeclampsia. Acta Obstet Gynecol Scand. 2009; 89(1):131-9. DOI: 10.3109/00016340903295618. View

Xia Y, Zhang Y, Yuan S, Chen J, Zheng W, Xu X . A nomogram to early predict isolation length for non-severe COVID-19 patients based on laboratory investigation: A multicenter retrospective study in Zhejiang Province, China. Clin Chim Acta. 2020; 512:49-57. PMC: 7836550. DOI: 10.1016/j.cca.2020.11.019. View

Ekun O, Olawumi O, Makwe C, Ogidi N . Biochemical Assessment of Renal and Liver Function among Preeclamptics in Lagos Metropolis. Int J Reprod Med. 2018; 2018:1594182. PMC: 6091329. DOI: 10.1155/2018/1594182. View

Tomimatsu T, Mimura K, Matsuzaki S, Endo M, Kumasawa K, Kimura T . Preeclampsia: Maternal Systemic Vascular Disorder Caused by Generalized Endothelial Dysfunction Due to Placental Antiangiogenic Factors. Int J Mol Sci. 2019; 20(17). PMC: 6747625. DOI: 10.3390/ijms20174246. View

Hu M, Li J, Baker P, Tong C . Revisiting preeclampsia: a metabolic disorder of the placenta. FEBS J. 2021; 289(2):336-354. DOI: 10.1111/febs.15745. View

10.

Zeisler H, Llurba E, Chantraine F, Vatish M, Staff A, Sennstrom M . Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia. N Engl J Med. 2016; 374(1):13-22. DOI: 10.1056/NEJMoa1414838. View

11.

Webster K, Fishburn S, Maresh M, Findlay S, Chappell L . Diagnosis and management of hypertension in pregnancy: summary of updated NICE guidance. BMJ. 2019; 366:l5119. DOI: 10.1136/bmj.l5119. View

12.

Pittara T, Vyrides A, Lamnisos D, Giannakou K . Pre-eclampsia and long-term health outcomes for mother and infant: an umbrella review. BJOG. 2021; 128(9):1421-1430. DOI: 10.1111/1471-0528.16683. View

13.

Gil M, Cuenca-Gomez D, Rolle V, Pertegal M, Diaz C, Revello R . Validation of machine-learning model for first-trimester prediction of pre-eclampsia using cohort from PREVAL study. Ultrasound Obstet Gynecol. 2023; 63(1):68-74. DOI: 10.1002/uog.27478. View

14.

Elawad T, Scott G, Bone J, Elwell H, Lopez C, Filippi V . Risk factors for pre-eclampsia in clinical practice guidelines: Comparison with the evidence. BJOG. 2022; 131(1):46-62. DOI: 10.1111/1471-0528.17320. View

15.

Tsoi S, Zheng J, Xu F, Kay H . Differential expression of lactate dehydrogenase isozymes (LDH) in human placenta with high expression of LDH-A(4) isozyme in the endothelial cells of pre-eclampsia villi. Placenta. 2001; 22(4):317-22. DOI: 10.1053/plac.2000.0620. View

16.

von Dadelszen P, Magee L, Roberts J . Subclassification of preeclampsia. Hypertens Pregnancy. 2003; 22(2):143-8. DOI: 10.1081/PRG-120021060. View

17.

von Dadelszen P, Payne B, Li J, Ansermino J, Broughton Pipkin F, Cote A . Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model. Lancet. 2010; 377(9761):219-27. DOI: 10.1016/S0140-6736(10)61351-7. View

18.

Duckitt K, Harrington D . Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ. 2005; 330(7491):565. PMC: 554027. DOI: 10.1136/bmj.38380.674340.E0. View

19.

Dimitriadis E, Rolnik D, Zhou W, Estrada-Gutierrez G, Koga K, Francisco R . Pre-eclampsia. Nat Rev Dis Primers. 2023; 9(1):8. DOI: 10.1038/s41572-023-00417-6. View

20.

Tarca A, Romero R, Erez O, Gudicha D, Than N, Benshalom-Tirosh N . Maternal whole blood mRNA signatures identify women at risk of early preeclampsia: a longitudinal study. J Matern Fetal Neonatal Med. 2020; 34(21):3463-3474. PMC: 10544754. DOI: 10.1080/14767058.2019.1685964. View