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. 2024 Jan 16:17:141-152.
doi: 10.2147/IJGM.S445374. eCollection 2024.

Development and Validation of a Multivariable Predictive Model for the Risk of Histologic Chorioamnionitis in Patients with Premature Rupture of Membranes in the Late Preterm and Term

Xinshui Wang  1 , Zheren Huang  2 , Yan Ma  2
Affiliations

Development and Validation of a Multivariable Predictive Model for the Risk of Histologic Chorioamnionitis in Patients with Premature Rupture of Membranes in the Late Preterm and Term

Xinshui Wang et al. Int J Gen Med. .

Abstract

Background: This study aimed to develop and validate a model to predict histologic chorioamnionitis (HCA) risk in late preterm and term premature rupture of membranes (PROM) patients using clinical and laboratory parameters.

Methods: We conducted a retrospective study on 116 late preterm and term PROM cases, divided into a training (n=81) and a validation set (n=35). A multivariable logistic regression model was developed using the training set. Performance was assessed via the area under the receiver operating characteristic curve (AUC) and net reclassification index (NRI). Decision curve analysis (DCA) evaluated the model's clinical utility. Additionally, nomograms and a web version of the model were developed.

Results: In the training set, the combined model constructed using maternal BMI, gravidity, amniotic fluid characteristics, and prenatal white blood cell (WBC) count showed significantly higher AUC than WBC alone (0.859 vs 0.710, P=0.010), with improved accuracy and sensitivity. In the validation set, the AUC of the combined model remained higher than that of WBC, but the difference was not statistically significant (0.728 vs 0.584, P=0.173). NRI analysis indicated that the combined model improved the correct classification of HCA by 25.0% (P=0.012) compared to that of WBC alone. DCA demonstrated that the combined model had a higher net benefit than WBC in most cases. The nomograms and web version of the model provided convenient tools for clinicians to predict the risk of HCA.

Conclusion: This study successfully developed and validated a clinically feasible multivariable model to predict the risk of HCA in women with late preterm and term PROM.

Keywords: histologic chorioamnionitis; laboratory indicators; late pregnancy; predictive model; premature rupture of membranes.

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Conflict of interest statement

The authors of this article declare to have no conflict of interest related to this study.

Figures

Figure 1
Figure 1
Flowchart of patient enrollment.
Figure 2
Figure 2
Comparison of the ROC curves for the combined model and WBC in predicting the risk of HCA in women with late preterm and term PROM (A): Training set; (B): Validation set); Calibration curves of the combined model (C): Training set; (D): Validation set; The horizontal axis represents the predicted incidence rate of HCA, while the vertical axis represents the observed incidence rate of HCA. The red line on the diagonal is the reference line, indicating a perfect match between predicted and actual values. The black line represents the calibration curve, and the yellow areas on both sides represent the 95% CI).
Figure 3
Figure 3
Comparison of the decision curves for the combined model and WBC in predicting the risk of HCA in women with late preterm and term PROM (A): Training set; (B) Validation set; The horizontal axis represents the threshold probability for HCA, while the vertical axis represents the patient’s standardized net benefit. The “All” curve represents the strategy where all patients receive treatment for HCA, and the “None” curve represents no treatment, serving as the baseline comparison).
Figure 4
Figure 4
Nomograms and web version of the model in predicting the risk of HCA in women with late preterm and term PROM (A–C): Nomogram of the model and its application; (D–F): Web version of the model and its application).
See this image and copyright information in PMC

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