Abstract:

Objective: To explore the influencing factors of adverse fetal outcomes in patients with preeclampsia (PE) based on a competing risk model and to construct a nomogram model. Methods: The clinical data of 338 PE patients admitted to the Second People's Hospital of Wuhu from January 2018 to October 2024 were retrospectively analyzed. A competing risk model was used to evaluate the influencing factors for adverse fetal outcomes in PE patients. A nomogram was plotted using the R3.4.3 software package, and the model was validated using the Bootstrap method. Calibration curves and receiver operator characteristic (ROC) curves were drawn to evaluate the calibration and predictive performance of the model. Results: The incidence rate of adverse fetal outcomes in PE patients was 46.75% (158/338), with the target event (adverse fetal outcomes due to PE) occurring at a rate of 37.87% (128/338), and the competing event (iatrogenic termination of pregnancy due to severe maternal complications before the occurrence of the target event) occurring at a rate of 8.88% (30/338). There were statistically significant differences among the three groups in gestational age at onset, abnormal umbilical artery blood flow, albumin (Alb), 24 h urine protein quantification, D-dimer (D-D), lactate dehydrogenase (LDH), and total bilirubin (TBIL) (all P<0.05). Multivariate competing risk model analysis showed that abnormal umbilical artery blood flow, high levels of 24 h urine protein quantification, high D-D levels, high LDH levels, and high TBIL levels were risk factors for adverse fetal outcomes in PE patients (all P<0.05), while advanced gestational age at onset and high Alb levels were protective factors (all P<0.05). The nomogram model constructed based on these influencing factors had a validated concordance index of 0.832, and its calibration curve showed good agreement with the ideal curve. The ROC curve demonstrated that the area under the curve, sensitivity, and specificity of the model for predicting adverse fetal outcomes in PE patients were 0.914, 87.97% and 85.00%, respectively. Conclusions: In the presence of competing risks, gestational age at onset, umbilical artery blood flow, Alb, 24 h urine protein quantification, D-D, LDH and TBIL are all influencing factors for adverse fetal outcomes in PE patients. The nomogram model constructed based on these factors exhibit good calibration and predictive performance.

Key words: Pre-eclampsia, Fetus, Pregnancy outcome, Root cause analysis, Nomograms, Competitive risk model