Preeclampsia Risk Prediction Model for Chinese Pregnant Patients With Systemic Lupus Erythematosus

Abstract

Objective. To screen for a high risk of preeclampsia in women with systemic lupus erythematosus (SLE). Methods. A total of 513 antenatal care records of pregnant patients with SLE were obtained, and the data were randomly assigned to either a development set (n = 342) or a validation set (n = 171). Preeclampsia predictors were identified with stepwise regression, and a coefficient B of each variable was used to establish a prediction model and risk scoring system. Goodness-of-fit was assessed by the Hosmer-Lemeshow and Omnibus tests, and the area under the receiver operating characteristic curve (area under the curve) was used to assess discrimination. Validation was performed using the validation set. Results. The preeclampsia incidence was 14.4% in the pregnant patients with SLE. A mean arterial pressure (MAP) ≥96.5 mm Hg (odds ratio [OR] 213.15 [95% confidence interval (95% CI) 24.39-999.99]), prepregnancy hypertension (OR 18.19 [95% CI 2.67-125.01]), a hematologic disorder (OR 4.13 [95% CI 1.03-16.67]), positive IgM anticardiolipin antibodies (aCLs) (OR 19.85 [95% CI 1.11-333.33]), serum albumin <31.5 grams/liter (OR 9.88 [95% CI 2.07-47.62]), serum uric acid ≥303 μmoles/liter (OR 5.58 [95% CI 1.40-22.22]), and 24-hour urinary protein ≥0.286 grams (OR 14.39 [95% CI 2.43-83.33]) were selected for the preeclampsia prediction model. The area under the curve was 0.975. Preeclampsia prediction model scores >4 indicated a high risk of preeclampsia. For the validation set, the preeclampsia prediction accuracy was 93.6% (sensitivity 88.5%, specificity 94.5%). Conclusion. A model for predicting the risk of preeclampsia in pregnant patients with SLE was established on the basis of MAP, prepregnancy hypertension, hematologic disorders, IgM aCLs, albumin, uric acid, and 24-hour urinary protein. The model had good predictive efficiency and can help clinicians improve pregnancy outcomes in high-risk women with early interventions.

Development and Validation of Multi-Stage Prediction Models for Pre-eclampsia: A Retrospective Cohort Study on Chinese Women

“…Jiang et al used demographic characteristics and biochemical markers (a complete blood count, serum albumin, serum uric acid, 24-h urinary protein, antinuclear antibodies, anti–double-stranded DNA antibody, antiphospholipid antibodies, etc.) to achieve an AUROC of 0.975 for pregnant women with systemic lupus erythematosus ( 23 ). Chen et al predicted the risk of early-onset preeclampsia for pregnant women with twin pregnancy, where the AUROC was 0.82 (95% CI: 0.76–0.88), and the detection rate was 40.7% (false positive 10%) ( 22 ).…”

“…However, these studies aimed at specific high-risk groups, or used expensive indicators that were not within the scope of routine testing, so it may not be conducive to promotion. In addition, these studies also have other limitations: not consider pre-eclampsia subtypes ( 23 – 26 ), possible bias caused by variable screening process ( 23 , 24 , 26 ), and insufficient number of outcome events ( 21 – 23 , 25 ).…”

“…However, these studies primarily focused on specific high-risk groups or used expensive biomarkers beyond the scope of routine testing, which limits their generalizability. In addition, these studies did not consider pre-eclampsia subtypes ( 23 – 26 ), possible bias caused by the process of variable selection ( 23 , 24 , 26 ), and insufficient number of outcome events ( 21 – 23 , 25 ).…”

Benefits of Hydroxychloroquine Combined with Low-Dose Aspirin on Pregnancy Outcomes and Serum Cytokines in Pregnant Women with Systemic Lupus Erythematosus

“…The physiological hypercoagulable state of pregnancy is crucial in self-protection of the body and may also induce pre-eclampsia, fetal growth restriction, and venous thromboembolism [ 7 ]. In pregnant patients with SLE, the effects of pregnancy superimposed on the pathophysiology of SLE may have a higher risk of thrombosis, often with adverse pregnancy outcomes [ 8 ]. Aspirin can reduce the degree of platelet activation, promote vasodilation, improve blood supply to the placenta, and prevent microthrombosis [ 9 ].…”

Supraphysiological estradiol promotes human T follicular helper cell differentiation and favours humoural immunity during in vitro fertilization

“…It has been reported that in some Th1‐driven autoimmune diseases, pregnancy can temporarily abate the clinical signs in the mother 7,8 . Humoural immunity is essential for protection against extracellular pathogens; however, excess autoantibody production during pregnancy may induce or aggravate autoimmune diseases such as rheumatic antiphospholipid syndrome and systemic lupus erythematosus 9‐11 . The mechanism underlying the relationship between maternal hormones and humoural immunity remains unclear.…”