A Predictive Model for Treatment Effectiveness in Severe Primary Immune Thrombocytopenia during Pregnancy: A Retrospective Study in a Tertiary Critical Maternity Referral Center.

IF 2 4区 医学 Q2 OBSTETRICS & GYNECOLOGY Gynecologic and Obstetric Investigation Pub Date : 2024-10-05 DOI:10.1159/000541721
Chuan Wang, Zhihong He, Ka U Lio, Haoting Shi, Jieying Wang, Yu Zhang, Ning Zhang
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Abstract

Objectives: The study aimed to identify factors influencing the severity of primary immune thrombocytopenia (ITP) during pregnancy, develop a predictive model for treatment response, and report maternal and neonatal outcomes associated with severe ITP.

Design: A retrospective analysis was conducted on 155 pregnancies with severe ITP between January 2018 and April 2023 at a tertiary critical maternity referral center in Shanghai, China. Participants/Materials: The study included 155 pregnancies diagnosed with severe ITP, divided into groups based on the lowest platelet count (<30 × 109/L vs. 30-50 × 109/L) and first-line treatment response (non-response vs. response).

Setting: The study was conducted at Renji Hospital, Shanghai Jiao Tong University School of Medicine, a tertiary critical maternity rescue referral center.

Methods: Clinical characteristics and outcomes were compared between groups. A multivariable logistic regression model was used to identify factors associated with the severity of ITP. A prediction model for treatment response was established using LASSO-logistic regression and internally validated.

Results: ITP severity was found to be correlated with low maximum amplitude of thromboelastography (OR 5.43, 95% CI: 1.48-16.00, p = 0.002), bleeding events (OR 4.91, 95% CI: 1.62-14.86, p = 0.005), and low reticulocytes (OR 2.40 × 10-7, 95% CI: 1.06 × 10-13 to 0.55, p = 0.04). Of the 118 patients who received first-line therapy, 52 (44%) responded. The dataset was randomly split into a training (N = 99) and test (N = 23) set with a ratio of 8:2. A predictive nomogram was created and internally validated showing good discrimination. The model yielded an area under receiver operating characteristic curve of 0.78 (0.69-0.87) and 0.85 (0.67-1.00) in the training and validation cohort, respectively. Earlier delivery and high rate of neonatal intensive care unit admission occurred with severe ITP and treatment failure.

Limitations: The study was limited by a relatively small sample size and the retrospective observational design, which imposed limitations on the assessment of treatment efficacy.

Conclusions: We identified clinical predictors of ITP severity and treatment resistance during pregnancy. A nomogram predicting first-line response was validated. These findings can facilitate clinical decision-making and counseling regarding this challenging pregnancy complication.

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妊娠期严重原发性免疫血小板减少症治疗效果的预测模型:一家三级危重孕产妇转诊中心的回顾性研究。
目的 该研究旨在确定影响妊娠期原发性免疫性血小板减少症(ITP)严重程度的因素,建立治疗反应预测模型,并报告与严重ITP相关的孕产妇和新生儿结局。设计 在中国上海的一家三级危重孕产妇转诊中心,对2018年1月至2023年4月期间155例重症ITP孕妇进行了回顾性分析。参与者/材料 该研究纳入了155例确诊为重症ITP的孕妇,根据最低血小板计数(<30×109/L vs. 30-50×109/L)和一线治疗反应(无反应 vs. 有反应)将其分为几组。研究地点 上海交通大学医学院附属仁济医院是一家三级危重孕产妇抢救转诊中心。方法 比较两组患者的临床特征和预后。采用多变量逻辑回归模型确定与 ITP 严重程度相关的因素。采用 LASSO 逻辑回归法建立了治疗反应预测模型,并进行了内部验证。结果 发现 ITP 严重程度与血栓弹力图(TEG)最大振幅(MA)低(OR 5.43,95% CI 1.48 至 16.00,p=0.002)、出血事件(OR 4.91,95% CI 1.62 至 14.86,p=0.005)和网状细胞低(OR 2.40×10-7,95% CI 1.06×10-13 至 0.55,p=0.04)相关。在接受一线治疗的 118 名患者中,有 52 人(44%)做出了反应。数据集以 8:2 的比例随机分为训练集(N=99)和测试集(N=23)。创建了一个预测提名图,并进行了内部验证,显示出良好的区分度。在训练组和验证组中,该模型的接收者操作特征曲线下面积(ROC)分别为 0.78(0.69 至 0.87)和 0.85(0.67 至 1.00)。严重的ITP和治疗失败会导致提早分娩和高NICU入院率。局限性 本研究受限于相对较小的样本量和回顾性观察设计,这对疗效评估造成了限制。结论 我们确定了妊娠期 ITP 严重程度和耐药性的临床预测因素。预测一线反应的提名图得到了验证。这些发现有助于针对这一具有挑战性的妊娠并发症做出临床决策和提供咨询服务。
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来源期刊
CiteScore
4.20
自引率
4.80%
发文量
44
审稿时长
6-12 weeks
期刊介绍: This journal covers the most active and promising areas of current research in gynecology and obstetrics. Invited, well-referenced reviews by noted experts keep readers in touch with the general framework and direction of international study. Original papers report selected experimental and clinical investigations in all fields related to gynecology, obstetrics and reproduction. Short communications are published to allow immediate discussion of new data. The international and interdisciplinary character of this periodical provides an avenue to less accessible sources and to worldwide research for investigators and practitioners.
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