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Prediction of postpartum hemorrhage in pregnant women with immune thrombocytopenia: development and validation of the MONITOR model in a nationwide multicenter study.

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机构： [1]Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Collaborative Innovation Center of Hematology, Beijing key laboratory of hematopoietic stem cell transplantation, Beijing, China., [2]Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China., [3]Department of Hematology, Navy General Hospital, Beijing, China., [4]Center of Hematologic Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China., [5]Department of Hematology, Beijing Hospital, Beijing, China., [6]Department of Hematology, People's Hospital of Hainan Province, Haikou, China., [7]State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China., [8]Department of Hematology, First People's Hospital of Hangzhou, Hangzhou, China., [9]Department of Hematology, First People's Hospital of Yunnan Province, Kunming, China., [10]Department of Hematology, Hebei Institute of Hematology, The Second Hospital of Hebei Medical University, Shijiazhuang, China., [11]Department of Hematology, He Ping Central Hospital of the Changzhi Medical College, Changzhi, China., [12]Department of Hematology, Second Hospital of Shanxi Medical University, Taiyuan, China., [13]Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fujian Medical University Union Hospital, Fuzhou, China., [14]Department of Hematology, Third Affiliated Hospital of Southern Medical University, Guangzhou, China., [15]Department of Hematology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China., [16]Department of Hematology, Beijing Tongren Hospital, Beijing, China., [17]Department of Hematology, Peking University Shenzhen Hospital, Shenzhen, China., [18]Department of Hematology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China., [19]Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China., [20]Department of Clinical Epidemiology, Peking University People's Hospital, Beijing, China., [21]Department of Internal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.

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关键词： Postpartum hemorrhage immune thrombocytopenia maternal mortality prediction model

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Globally, postpartum hemorrhage (PPH) is the leading cause of maternal death. Women with immune thrombocytopenia (ITP) are at increased risk of developing PPH. Early identification of PPH helps to prevent adverse outcomes but is underused because clinicians do not have a tool to predict PPH for women with ITP. We therefore conducted a nationwide multicenter retrospective study to develop and validate a prediction model of PPH in patients with ITP. We included 432 pregnant women (677 pregnancies) with primary ITP from 18 academic tertiary centers in China from Jan 2008 to Aug 2018. A total of 157 (23.2%) pregnancies experienced PPH. The derivation cohort included 450 pregnancies. For the validation cohort, we included 117 pregnancies in the temporal validation cohort and 110 pregnancies in the geographical validation cohort. We assessed 25 clinical parameters as candidate predictors and used multivariable logistic regression to develop our prediction model. The final model included seven variables and was named MONITOR (maternal complication, WHO bleeding score, antepartum platelet transfusion, placental abnormalities, platelet count, previous uterine surgery, and primiparity). We established an easy-to-use risk heatmap and risk score of PPH based on the seven risk factors. We externally validated this model using both a temporal validation cohort and a geographical validation cohort. The MONITOR model had an AUC of 0.868 (95% CI 0.828-0.909) in internal validation, 0.869 (95% CI 0.802-0.937) in the temporal validation, and 0.811 (95% CI 0.713-0.908) in the geographical validation. Calibration plots demonstrated good agreement between MONITOR-predicted probability and actual observation in both internal validation and external validation. Therefore, we developed and validated a very accurate prediction model for PPH. We hope that the model will contribute to more precise clinical care, decreased adverse outcomes, and better health care resource allocation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

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出版当年[2021]版：

大类 | 1 区

医学

小类 | 2 区血液学

最新[2023]版：

大类 | 1 区

医学

小类 | 2 区血液学

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出版当年[2020]版：

Q1 HEMATOLOGY

最新[2023]版：

Q1 HEMATOLOGY

影响因子： 10.1 最新[2023版] 10.1 最新五年平均 10.047 出版当年[2020版] 7.954 出版当年五年平均 6.973 出版前一年[2019版] 13.268 出版后一年[2021版]

第一作者：

第一作者机构： [1]Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Collaborative Innovation Center of Hematology, Beijing key laboratory of hematopoietic stem cell transplantation, Beijing, China.,

通讯作者：

通讯机构： [1]Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Collaborative Innovation Center of Hematology, Beijing key laboratory of hematopoietic stem cell transplantation, Beijing, China., [*1]No. 11 Xizhimen South Street, Xicheng District, Beijing, China

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Prediction of postpartum hemorrhage in pregnant women with immune thrombocytopenia: development and validation of the MONITOR model in a nationwide multicenter study.

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