Construction and application of fetal loss risk model in systemic lupus erythematosus patients with mild disease severity

TL;DR

A new model predicts the risk of fetal loss in pregnant women with mild systemic lupus erythematosus, helping guide pre-conception care.

Contribution

Development of a nomogram model to predict fetal loss in mild SLE pregnancies using clinical and laboratory features.

Findings

The nomogram model achieved good discriminatory power with an AUC of 0.867.

External validation confirmed the model's predictive ability for fetal loss risk.

The model showed clinical importance for fetal loss probabilities between 10% and 70%.

Abstract

This dynamic nomogram model was developed to predict the probability of fetal loss in pregnant patients with systemic lupus erythematosus (SLE) with mild disease severity before conception.

An analysis was conducted on 314 pregnancy records of patients with SLE who were hospitalized between January 2015 and January 2022 at Shenzhen People's Hospital, and the Longhua Branch of Shenzhen People's Hospital. Data from the Longhua Branch of the Shenzhen People's Hospital were utilized as an independent external validation cohort. The nomogram, a widely used statistical visualization tool to predict disease onset, progression, prognosis, and survival, was created after feature selection using multivariate logistic regression analysis. To evaluate the model prediction performance, we employed the receiver operating characteristic curve, calibration curve, and decision curve analysis.

Lupus nephritis, complement 3, immunoglobulin G, serum albumin, C-reactive protein, and hydroxychloroquine were all included in the nomogram model. The model demonstrated good calibration and discriminatory power, with an area under the curve of 0.867 (95% confidence interval: 0.787–0.947). According to decision curve analysis, the nomogram model exhibited clinical importance when the probability of fetal loss in patients with SLE ranged between 10 and 70%. The predictive ability of the model was demonstrated through external validation.

The predictive nomogram approach may facilitate precise management of pregnant patients with SLE with mild disease severity before conception.

The online version contains supplementary material available at 10.1186/s12884-024-06679-6.

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