ÖZET
Amaç:
Bu çalışmada koronavirüs hastalığı-2019 (COVİD-19) tanılı gebe ve postpartum kadınların yoğun bakım ihtiyacını öngörebilecek tahmin modeli oluşturulması amaçlanmıştır.
Gereç ve Yöntem:
Tek merkezli ve retrospektif olarak planlanan çalışma Nisan 2020 ve Aralık 2021 tarihlerinde COVİD-19 tanılı ve kadın doğum kliniğine kabul edilen 18 yaş üzeri gebe ve postpartum hastalar ile yapıldı. Tahmin modeli oluşturulması için hastaların klinik özellikleri, laboratuvar değerleri ve radyolojik özellikleri kaydedildi. Tahmin için iki farklı çok değişkenli lojistik regresyon modeli ve Naive Bayes sınıflandırma algoritması kullanıldı. Geliştirilen tahmin modellerinin sonuçları nomogram ile özetlendi ve tahmin başarıları alıcı işletim karakteristik (ROC) eğrisi ile değerlendirildi.
Bulgular:
Çalışmaya 436 gebe ve postpartum hasta dahil edildi. Yoğun bakıma yatırılan 51 hastadan 12’si eksitus oldu. Yoğun bakıma yatış risk faktörlerini belirlemek için oluşturduğumuz üç faklı sınıflama modelinin spesifitelerinin %95’in üzerinde ve sensitivitelerinin sırasıyla %70,6, %86,3 ve %87 olduğu belirlendi. Ayrıca ROC’un altındaki alan değerlerinin modeller için sırasıyla 0,94, 0,941 ve 0,978 olduğu bulundu. Yüksek prokalsitonin seviyesi, ateş, dispne ve orta-ağır radyolojik tutulum varlığının gebe ve postpartum kadınlarda yoğun bakım yatışı ile ilişkili risk faktörleri olarak belirlendi.
Sonuç:
Geliştirdiğimiz risk modelinin uygulanması kolay ve erken dönemde ağır COVİD-19 hastalık riski taşıyan gebeleri belirlemeye ve önlem alınmasına yardımcı olacağı düşünülmektedir
References
1
Siston AM, Rasmussen SA, Honein MA, Fry AM, Seib K, Callaghan WM, et al. Pandemic 2009 Influenza A(H1N1) virus illness among pregnant women in the United States. JAMA 2010;303:1517-25.
2
Di Mascio D, Khalil A, Saccone G, Rizzo G, Buca D, Liberati M, et al. Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis. Am J ObstetGynecol MFM 2020;2:100107.
3
Oakes MC, Kernberg AS, Carter EB, Foeller ME, Palanisamy A, Raghuraman N, et al. Pregnancy as a risk factor for severe coronavirus disease 2019 using standardized clinical criteria. Am J ObstetGynecol MFM 2021;3:100319.
4
DeBolt CA, Bianco A, Limaye MA, Silverstein J, Penfield CA, Roman AS, et al. Pregnant women with severe or critical coronavirus disease 2019 have increased composite morbidity compared with nonpregnant matched controls. Am J Obstet Gynecol 2021;224:510.
5
McClymont E, Albert AY, Alton GD, Boucoiran I, Castillo E, Fell DB, et al. Association of SARS-CoV-2 Infection During Pregnancy With Maternal and Perinatal Outcomes. JAMA 2022;327:1983-91.
6
Zhou Y, He Y, Yang H, Yu H, Wang T, Chen Z, et al. Development and validation a nomogram for predicting the risk of severe COVID-19: A multi-center study in Sichuan, China. PLoS One 2020;15:e0233328.
7
Woo SH, Rios-Diaz AJ, Kubey AA, Cheney-Peters DR, Ackermann LL, Chalikonda DM, et al. Development and Validation of a Web-Based Severe COVID-19 Risk Prediction Model. Am J Med Sci 2021;362:355-62.
8
Zhao Z, Chen A, Hou W, Graham JM, Li H, Richman PS, et al. Prediction model and risk scores of ICU admission and mortality in COVID-19. PLoS One 2020;15:e0236618.
9
Kalafat E, Prasad S, Birol P, Tekin AB, Kunt A, Di Fabrizio C, et al. An internally validated prediction model for critical COVID-19 infection and intensive care unit admission in symptomatic pregnant women. Am J Obstet Gynecol 2022;226:403.
10
Yao R, Martin CB, Haase VS, Tse BC, Nishino M, Gheorghe C, et al. Initial clinical characteristics of gravid severe acute respiratory syndrome coronavirus 2-positive patients and the risk of progression to severe coronavirus disease 2019. Am J ObstetGynecol MFM 2021;3:100365.
11
Tutiya C, Mello F, Chaccur G, Almeida C, Galvão E, Barbosa de Souza AC, et al. Risk factors for severe and critical Covid-19 in pregnant women in a single center in Brazil. J Matern Fetal Neonatal Med 2022;35:5389-92.
12
Wong HYF, Lam HYS, Fong AH, Leung ST, Chin TW, Lo CSY et al. Frequency and Distribution of Chest Radiographic Findings in Patients Positive for COVID-19. Radiology 2020;296:72-8.
13
Li K, Wu J, Wu F, Guo D, Chen L, Fang Z, et al. The Clinical and Chest CT Features Associated With Severe and Critical COVID-19 Pneumonia. Invest Radiol 2020;55:327-31.
14
COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines.National Institutes of Health.Accessed at https://www.covid19treatmentguidelines.nih.gov/.
15
Hosmer DW, Lemeshow S: Applied Survival Analysis: Regression Modeling of Time to Event Data New York: Wiley;1999.
16
AY Ng. Feature selection, l1 vs. l2 regularization, and rotational invariance. In International Conference on Machine Learning. 2004.
17
Bertens LC, Moons KG, Rutten FH, van Mourik Y, Hoes AW, Reitsma JB. A nomogram was developed to enhance the use of multinomial logistic regression modeling in diagnostic research. J ClinEpidemiol 2016;71:51-7.
18
Martinez-Portilla RJ, Sotiriadis A, Chatzakis C, Torres-Torres J, Espino Y Sosa S, Sandoval-Mandujano K, et al. Pregnant women with SARS-CoV-2 infection are at higher risk of death and pneumonia: propensity score matched analysis of a nationwide prospective cohort (COV19Mx). Ultrasound Obstet Gynecol 2021;57:224-31.
19
Villar J, Ariff S, Gunier RB, Thiruvengadam R, Rauch S, Kholin A, et al. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection: The INTERCOVID multinational cohort study. JAMA Pediatr 2021;175:817-26.
20
Fell DB, Dhinsa T, Alton GD, Török E, Dimanlig-Cruz S, Regan AK, et al. Association of COVID-19 Vaccination in Pregnancy With Adverse Peripartum Outcomes. JAMA 2022;327:1478-87.
21
Centers for Disease Control and Prevention. V-safe COVID-19 vaccine pregnancy registry. CDC February 11, 2020.
22
Munshi L, Wright JK, Zipursky J, Jorgensen S, Bogler T, et al. The incidence, severity, and management of COVID-19 across acutely ill pregnant individuals. Science Briefs of the Ontario COVID-19 Science Advisory Table 2021;2. Doi: 10.47326/ocsat.2021.02.43.1.0
23
Liang W, Liang H, Ou L, Chen B, Chen A, Li C, et al. Development and Validation of a Clinical Risk Score to Predict the Occurrence of Critical Illness in Hospitalized Patients With COVID-19. JAMA Intern Med 2020;180:1081-9.
24
Leoni MLG, Lombardelli L, Colombi D, Bignami EG, Pergolotti B, Repetti F, et al. Prediction of 28-day mortality in critically ill patients with COVID-19: Development and internal validation of a clinical prediction model. PLoS One 2021;16:e0254550.
25
Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: Living systematic review and meta-analysis. BMJ 2020;370:3320.
26
Takemoto M, Menezes MO, Andreucci CB, Knobel R, Sousa L, Katz L, et al. Brazilian Group for Studies of COVID-19 and Pregnancy. Clinical characteristics and risk factors for mortality in obstetric patients with severe COVID-19 in Brazil: a surveillance database analysis. BJOG 2020;127:1618-26.
27
Karimi L, Makvandi S, Vahedian-Azimi A, Sathyapalan T, Sahebkar A. Effect of COVID-19 on Mortality of Pregnant and Postpartum Women: A Systematic Review and Meta-Analysis. J Pregnancy 2021;2021:8870129.
28
Tang BM, Eslick GD, Craig JC, McLean AS. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis 2007;7:210-7.
29
Tan L, Wang Q, Zhang D, Ding J, Huang Q, Tang YQ, et al. Correction: Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study. Signal Transduct Target Ther 2020;5:61.
