The predictive value of SAA and NLR for adverse pregnancy outcomes in patients with severe preeclampsia treated by multidisciplinary team / 中华急诊医学杂志

ABSTRACT

Objective:To evaluate the predictive value of serum amyloid A (SAA) and neutrophil-lymphocyte ratio (NLR) for adverse pregnancy outcomes in patients with severe preeclampsia treated by multidisciplinary team.Methods:A total of 105 patients with severe preeclampsia admitted to the ICU of Hangzhou First People's Hospital from October 2014 to July 2022 were retrospectively enrolled. They were divided into the adverse pregnancy outcome group ( n = 62) and the non-adverse pregnancy outcome group ( n = 43) according to the pregnancy outcome. SAA, NLR and other laboratory indicators and related clinical data of all patients were collected within 24 h after admission. The general clinical data of the two groups were compared, and multivariate Logistic regression analysis was used to find the risk factors affecting adverse pregnancy outcome of patients with severe preeclampsia. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of SAA and NLR for adverse pregnancy outcomes in patients with severe preeclampsia treated by multidisciplinary team. Results:The ICU length of stay [4.00 (3.00, 5.00) vs. 3.00 (3.00, 4.00), P=0.022], acute physiology and chronic health evaluationⅡ (APACHEⅡ) score [9.00 (7.00, 11.25) vs. 7.00 (5.00, 9.00), P=0.002], white blood cell count [(12.29±4.25) vs. (10.41±4.00), P=0.025], SAA [37.85 (11.00, 72.83) vs. 9.00 (8.00, 20.70), P<0.001] and NLR [7.95 (5.22, 12.37) vs. 5.20 (3.25, 8.77), P=0.002] in the adverse pregnancy outcome group were higher than those in the non-adverse pregnancy outcome group. The gestational weeks [30.00 (26.75, 31.00) vs. 33.00 (32.00, 35.00), P<0.001], direct bilirubin [2.10 (1.50, 2.50) vs. 2.20 (1.90, 4.60), P=0.019] and alkaline phosphatase (99.00 (74.00, 124.25) vs. 133.00 (95.00, 188.00), P<0.001] levels in the adverse pregnancy outcome group were significantly lower than those in the non-adverse pregnancy outcome group ( P<0.05). Multivariate Logistic regression analysis showed that earlier gestational weeks ( OR=0.564, 95% CI 0.408-0.780, P<0.001), higher SAA ( OR=1.028, 95% CI 1.002-1.055, P=0.036) and APACHE Ⅱ score ( OR=1.282, 95%CI 1.048-1.569, P=0.016) were the risk factors affecting adverse pregnancy outcomes in patients with severe preeclampsia. The area under the curve of SAA, NLR and SAA, NLR combined with APACHE Ⅱ score were 0.770, 0.678, and 0.844, respectively. The combined prediction efficiency of SAA, NLR and APACHE Ⅱ score was higher than that of single prediction ( P<0.05). Conclusions:SAA and NLR have good predictive efficacy for adverse pregnancy outcomes in patients with severe preeclampsia treated by multidisciplinary team. The predictive efficacy of SAA and NLR combined with APACHE Ⅱ score is higher than that of single index.