背景:开发了这种动态列线图模型,以预测受孕前疾病严重程度较轻的系统性红斑狼疮(SLE)孕妇的胎儿丢失概率。
方法:对2015年1月至2022年1月在深圳市人民医院住院的314例SLE患者的妊娠记录进行分析。深圳市人民医院龙华分院。深圳市人民医院龙华分院的数据被用作独立的外部验证队列。列线图,一种广泛使用的统计可视化工具来预测疾病发作,programming,预后,和生存,在使用多变量逻辑回归分析进行特征选择后创建。为了评估模型预测性能,我们使用了接收器工作特性曲线,校正曲线,和决策曲线分析。
结果:狼疮性肾炎,补体3,免疫球蛋白G,血清白蛋白,C反应蛋白,和羟氯喹均包括在列线图模型中。该模型显示出良好的校准和判别能力,曲线下面积为0.867(95%置信区间:0.787-0.947)。根据决策曲线分析,当SLE患者的胎儿丢失概率在10%至70%之间时,列线图模型显示出临床重要性.通过外部验证证明了模型的预测能力。
结论:预测列线图方法可能有助于在受孕前对患有轻度疾病严重程度的SLE的妊娠患者进行精确管理。
BACKGROUND: This dynamic nomogram model was developed to predict the probability of fetal loss in pregnant patients with systemic lupus erythematosus (SLE) with mild disease severity before conception.
METHODS: An analysis was conducted on 314 pregnancy records of patients with SLE who were hospitalized between January 2015 and January 2022 at Shenzhen People\'s Hospital, and the Longhua Branch of Shenzhen People\'s Hospital. Data from the Longhua Branch of the Shenzhen People\'s Hospital were utilized as an independent external validation cohort. The nomogram, a widely used statistical visualization tool to predict disease onset, progression, prognosis, and survival, was created after feature selection using multivariate logistic regression analysis. To evaluate the model prediction performance, we employed the receiver operating characteristic curve, calibration curve, and decision curve analysis.
RESULTS: Lupus nephritis, complement 3, immunoglobulin G, serum albumin, C-reactive protein, and hydroxychloroquine were all included in the nomogram model. The model demonstrated good calibration and discriminatory power, with an area under the curve of 0.867 (95% confidence interval: 0.787-0.947). According to decision curve analysis, the nomogram model exhibited clinical importance when the probability of fetal loss in patients with SLE ranged between 10 and 70%. The predictive ability of the model was demonstrated through external validation.
CONCLUSIONS: The predictive nomogram approach may facilitate precise management of pregnant patients with SLE with mild disease severity before conception.