A Visual Prognostic Model of Delivery Time in Preeclampsia Patients: A Nationwide Retrospective Analysis of 7005 Patients

Purpose: Preeclampsia (PE) is a common complication during pregnancy that seriously affects the health of both the mother and child due to its insidious onset and delayed diagnosis. Therefore, a retrospective evaluation is necessary for developing a clinical nomogram for predicting prognosis among PE patients. Methods: We developed a nomogram to predict PE prognosis based on 5058 patients recruited from Shandong Province, China between January 2012 and November 2017; then, we externally validated the nomogram in a separate cohort of 1947 patients across China by testing the calibration and discrimination of the nomogram in predicting the delivery time among PE patients. Results: According to forward stepwise linear regression analyses, the time of hypertension onset (TOH) is the most predictive factor in the prognosis of patients with PE, followed by the urine protein, serum creatinine, and alkaline phosphatase levels and ten other clinical parameters. Then, we developed a prognostic visualized nomogram and a risk assessment table to predict the outcome of PE patients and found that PE patients with high scores may have an earlier delivery time; this finding was validated by performing calibration and discrimination analyses, and the agreement between the nomogram predictions and actual delivery times was excellent in both the primary and validation cohorts. In addition, this nomogram could estimate the fetal prognosis. Conclusion: We established and validated a nomogram that can predict the prognosis of PE patients. This practical prognostic PE model may be helpful for clinicians in making clinical decisions and providing treatment. Funding Statement: This work was supported by the National Key Research and Development Program of China (2016YFC1000300), the National Natural Science Foundation of China (81371499, 81170688, 81470973, and 81770679), the Shandong Provincial Natural Science Foundation, China (ZR2009CM094). Declaration of Interests: The authors declare there is no potential conflict of interests. Ethics Approval Statement: Ethical approval was obtained from the Institutional Review Boards by the respective participating institutions, and all PE patients provided signed written informed consent.