Evaluation of risk factors and establishment of risk score model for postpartum blood transfusion volume
Objective To evaluate the risk factors related to postpartum blood transfusion volume and establish a risk scoring model.Methods A total of 557 postpartum patients who received transfusions at the Northwest Women and Children's Hospital from May 31,2021,to May 31,2023,were selected as study subjects,and were divided into＜800mL(n=345)and≥800mL(n=212)groups according to blood transfusion volume.A random sample of 389 cases(70％)was used as the training set,and 168 cases(30％)as the validation set.Maternal information was collected according to literature and clinical practice,Logistic regression model and random forest model were constructed for variable analysis,and variables that might be related to postpartum hemorrhage were screened and verified.Results Multivariate Logistic regression analysis results indicated that severe anemia,hypoproteinemia,coagulopathy,dangerous placenta previa and placenta implantation during pregnancy were the risk factors influencing postpartum transfusion volume,with OR values and 95％CI were 3.25(1.66-6.36),2.64(1.60-4.35),3.12(1.12-5.28),2.55(1.19-4.63),1.98(1.02-3.82),respectively.The area under receiver operating characteristic(ROC)curve(AUC)of training set and validation set were 0.739 and 0.694,respectively.Cross-validation,decision curve analysis(DCA)and clinical impact curve(CIC)all demonstrated good clinical guidance function.The random forest model validation results showed that the top five risk factors for transfusion in the training set included anemia,hypoproteinemia,coagulopathy,placenta previa,and placenta implantation(validation AUC=0.803),consistent with the multivariate regression results.Conclusion Anemia,hypoproteinemia,coagulopathy,dangerous placenta previa and placenta implantation are independent risk factors related to postpartum blood transfusion volume,which can guide clinical blood preparation and selection of appropriate surgical methods.
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