Risk Prediction for Peripartum Cardiomyopathy in Delivering Mothers: A Validated Risk Model

医学 置信区间 围产期心肌病 接收机工作特性 逻辑回归 优势比 医疗补助 曲线下面积 糖尿病 内科学 心肌病 心力衰竭 医疗保健 内分泌学 经济 经济增长
作者
Melinda B. Davis,Jennifer L. Jarvie,Ellise Gambahaya,JoAnn Lindenfeld,David P. Kao
出处
期刊:Journal of Cardiac Failure [Elsevier BV]
卷期号:27 (2): 159-167 被引量:9
标识
DOI:10.1016/j.cardfail.2020.12.022
摘要

Background Peripartum cardiomyopathy (PPCM) causes significant morbidity and mortality in childbearing women. Delays in diagnosis lead to worse outcomes; however, no validated risk prediction model exists. We sought to validate a previously described model and identify novel risk factors for PPCM presenting at the time of delivery. Methods and Results Administrative hospital records from 5,277,932 patients from 8 states were screened for PPCM, identified by International Classification of Disease-9 Clinical Modification codes (674.5x) at the time of delivery. Demographics, comorbidities, procedures, and outcomes were quantified. Performance of a previously published regression model alone and with the addition of novel PPCM-associated characteristics was assessed using receiver operating characteristic area under the curve (AUC) analysis. Novel risk factors were identified using multivariate logistic regression and the likelihood ratio test. In total, 1186 women with PPCM were studied, including 535 of 4,003,912 delivering mothers (0.013%) in the derivation set compared with 651 of 5,277,932 (0.012%) in the validation set. The previously published risk prediction model performed well in both the derivation (area under the curve 0.822) and validation datasets (area under the curve 0.802). Novel PPCM-associated characteristics in the combined cohort included diabetes mellitus (odds ratio [OR] of PPCM 1.93, 95% confidence interval [CI] 1.23–3.02, P = .004), mood disorders (OR 1.74, 95% CI 1.22–2.47, P = .002), obesity (OR 1.92, 95% CI 1.45–2.55, P < .001), and Medicaid insurance (OR 1.54, 95% CI 1.22-1.96, P < .001). Conclusions This is the first validated risk prediction model to identify women at increased risk for PPCM at the time of delivery. Diabetes mellitus, obesity, mood disorders, and lower socioeconomic status are risk factors associated with PPCM. This model may be useful for identifying women at risk and preventing delays in diagnosis.
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