Prediction of fetal loss in Chinese pregnant patients with systemic lupus erythematosus : a retrospective cohort study

Abstract

Objective To develop a predictive model for fetal loss in women with systemic lupus erythematosus (SLE). Design A retrospective cohort study. Setting Data were collected in a tertiary medical centre, located in Shanghai, China, from September 2011 to May 2017. Participants 338 pregnancies with SLE were analysed retrospectively. Cases of multiple pregnancy and those in which artificial abortion was performed for personal reasons were excluded. Primary outcome measures Fetal loss was the primary outcome. A stepwise regression to identify the predictors related to the fetal loss and coefficient B of each variable was used to develop a predictive model and make a corresponding risk classification. The Hosmer-Lemeshow test, Omnibus test and area under the receiver-operating characteristic curve (AUC) were used to assess the goodness-of-fit and discrimination of the predictive model. A 10-fold cross validation was used to assess the model for overfitting. Results Unplanned pregnancies (OR 2.84, 95% CI 1.12 to 7.22), C-3 hypocomplementemia (OR 5.46, 95% CI 2.30 to 12.97) and 24 hour-urinary protein level (0.3 <= protein< 1.0 g/24 hours: OR 2.10, 95% CI 0.63 to 6.95; protein >= 1.0 g/24 hours: OR 5.89, 95% CI 2.30 to 15.06) were selected by the stepwise regression. The Hosmer-Lemeshow test resulted in p=0.325; the Omnibus test resulted in p< 0.001 and the AUC was 0.829 (95% CI 0.744 to 0.91) in the regression model. The corresponding risk score classification was divided into low risk (0-3) and high risk groups (> 3), with a sensitivity of 60.5%, a specificity of 93.3%, positive likelihood ratio of 9.03 and negative likelihood ratio of 0.42. Conclusions A predictive model for fetal loss in women with SLE was developed using the timing of conception, C-3 complement and 24 hour-urinary protein level. This model may help clinicians in identifying women with high risk pregnancies, thereby carrying out monitoring or/and interventions for improving fetal outcomes.