The study on the Nomogram model for predicting the risk of concurrent infection in patients with postpartum hemorrhage after cesarean section
Objective To establish a Nomogram model for predicting the risk of co-infection in patients with postpartum hemorrhage(PPH)during cesarean section.Methods 222 cases of cesarean PPH patients admitted to the Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital from September 2021 to September 2023 were selected and divided into cesarean PPH-infected patients(infected group,111 patients)and cesarean PPH-uninfected patients(uninfected group,111 patients)according to whether they were infected or not.Clinical data and blood routine indexes[white blood cells,C-reactive protein(CRP),neutrophils]at different time points of the two groups were analyzed,and the correlation between blood routine indexes and patients with concurrent infection was analyzed.Lasso-Logistic regression analysis was conducted to analyze the influencing factors of co-infection in patients,and a Nomogram model for predicting the risk of co-infection was constructed.C-index,ROC curve and calibration curve were used to test and evaluate the model.Results The proportion of patients aged ≥35 years old,placenta previa and premature rupture of membranes in infected group were higher than those in uninfected group(P＜0.05);white blood cell,CRP,and neutrophils at 1 day and 3 days after delivery in the infected group were higher than before delivery and higher than those in the uninfected(P＜0.05);white blood cell,CRP,neutrophils on day 1 and day 3 after delivery were positively correlated with concurrent infection(P＜0.05),and white blood cells at 1 day after delivery,neutrophils and CRP at 3 days after delivery were more strongly correlated with concurrent infection.Lasso-Logistic regression showed that placenta previa,premature rupture of membranes,white blood cells 1 day after delivery,neutrophils 1 day after delivery and CRP 3 days after delivery were significantly correlated with infection in PPH patients after cesarean section(P＜0.05);based on the above factors,a Nomogram model was constructed to predict the risk of co-infection,C-index prediction showed that the model had good differentiation,with a sensitivity of 91.89％and a specificity of 81.98％,the calibration curve fitted well with the ideal curve.Conclusion The influencing factors of concurrent infections in PPH patients delivered by cesarean section are placenta previa,premature rupture of membranes,leukocytes at 1 day after delivery,neutrophils at 1 day after delivery,and CRP at 3 days after delivery,and the Nomogram model for predicting the risk of concurrent infections construct on the basis of the above factors has a good discriminatory degree and predictive value.
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