The clinical predictive value of thrombelastography combined with the systemic immune-inflammation index for postpartum hemorrhage after vaginal delivery

doi:10.11958/20253593

Abstract

Abstract:

Objective To investigate the clinical predictive value of thromboelastography (TEG) combined with systemic immune-inflammation index (SII) for postpartum hemorrhage (PPH) in vaginal delivery. Methods A total of 199 puerperae undergoing vaginal delivery in our hospital were retrospectively enrolled, and they were divided into the PPH group (48 cases) and the non-PPH group (151 cases) according to inclusion and exclusion criteria. General clinical data, coagulation function indicators, blood routine indicators, TEG parameters and SII levels were compared between the two groups. The predictive value of TEG parameters, SII levels and their combined detection for PPH was analyzed by receiver operating characteristic (ROC) curve, and multivariate Logistic regression analysis was performed to identify independent risk factors for PPH. Results Compared with the non-PPH group, there were higher incidence of previous PPH history, pregnancy induced hypertension, pregnancy induced diabetes, prenatal anemia, oxytocin use, instrument assisted delivery and abnormal placental exfoliation in the PPH group, and longer prothrombin time (PT), activated partial thromboplastin time (APTT), higher levels of white blood cell count (WBC), neutrophil count (NEUT) and SII, and lower lymphocyte count (LYM), hemoglobin (Hb) and platelet count (PLT) in the PPH group (all P<0.05). The solidification time (K) in the PPH group was significantly higher than that in the non PPH group, while the maximum amplitude (MA) and coagulation index (CI) were significantly lower than those in the non PPH group (all P<0.01). ROC curve analysis showed that the area under the curve (AUC) for predicting PPH using K value, MA value, CI value, SII and their combined values were 0.706, 0.795, 0.746, 0.766 and 0.917, respectively. The efficiency of joint prediction is the highest, with a sensitivity of 81.63% and a specificity of 91.49%. Multivariate Logistic regression analysis revealed that elevated K value and SII were independent risk factors for PPH (all P<0.05), while elevated MA value and CI value were independent protective factors for PPH (P<0.05). Conclusion TEG parameters and SII are closely related to the occurrence of postpartum hemorrhage during vaginal delivery. The combined detection of the two has good predictive value for PPH.

Key words: postpartum hemorrhage, thrombelastography, ROC curve, systemic immune inflammatory index

CLC Number:

R714

Figures/Tables 5

References 17

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组别				n		年龄/岁				孕周/周			BMI/（kg/m²）							既往流产史
非PPH组				151		28.56±3.82				39.01±1.05			24.56±2.18							12（7.95）
PPH组				48		29.35±3.17				38.87±1.12			25.12±2.35							7（14.58）
t或χ²						1.429				0.813			1.526							1.857
组别					既往 PPH史			妊娠期高血压				妊娠期糖尿病				产前贫血					产程时间/h
非PPH组					2（1.32）			14（9.27）				15（9.93）				25（16.56）					8.53±3.15
PPH组					5（10.42）			13（27.08）				11（22.92）				17（29.17）					9.24±3.52
t或χ²					8.872^＊			9.854^＊＊				5.405^＊				7.781^＊					0.003
组别	羊水异常						巨大儿				使用催产素				器械助产			胎盘剥离异常
非PPH组	13（8.61）						25（16.56）				26（21.19）				32（21.19）			13（8.61）
PPH组	9（18.75）						7（14.58）				19（39.58）				21（43.75）			11（22.92）
χ²	3.809						0.105				10.410^＊				9.485^＊			7.985^＊
组别			新生儿体质量/g							PT/s				APTT/s			WBC（×10⁹/L）
非PPH组			3295.42±352.16							12.15±0.58				30.24±1.85			9.25±1.06
PPH组			3402.50±398.74							12.86±0.72				32.67±2.13			10.68±1.56
t			1.776							6.938^＊＊				7.637^＊＊			5.929^＊
组别		LYM（×10⁹/L）							NEUT（×10⁹L）					Hb（g/L）					PLT（×10⁹/L）
非PPH组		2.15±0.48							6.24±1.06					117.36±8.42					210.18±32.15
PPH组		1.62±0.42							7.19±1.13					108.65±9.17					169.42±28.67
t		6.857^＊＊							5.322^＊＊					6.107^＊＊					7.846^＊＊

组别				n		年龄/岁				孕周/周			BMI/（kg/m²）							既往流产史
非PPH组				151		28.56±3.82				39.01±1.05			24.56±2.18							12（7.95）
PPH组				48		29.35±3.17				38.87±1.12			25.12±2.35							7（14.58）
t或χ²						1.429				0.813			1.526							1.857
组别					既往 PPH史			妊娠期高血压				妊娠期糖尿病				产前贫血					产程时间/h
非PPH组					2（1.32）			14（9.27）				15（9.93）				25（16.56）					8.53±3.15
PPH组					5（10.42）			13（27.08）				11（22.92）				17（29.17）					9.24±3.52
t或χ²					8.872^＊			9.854^＊＊				5.405^＊				7.781^＊					0.003
组别	羊水异常						巨大儿				使用催产素				器械助产			胎盘剥离异常
非PPH组	13（8.61）						25（16.56）				26（21.19）				32（21.19）			13（8.61）
PPH组	9（18.75）						7（14.58）				19（39.58）				21（43.75）			11（22.92）
χ²	3.809						0.105				10.410^＊				9.485^＊			7.985^＊
组别			新生儿体质量/g							PT/s				APTT/s			WBC（×10⁹/L）
非PPH组			3295.42±352.16							12.15±0.58				30.24±1.85			9.25±1.06
PPH组			3402.50±398.74							12.86±0.72				32.67±2.13			10.68±1.56
t			1.776							6.938^＊＊				7.637^＊＊			5.929^＊
组别		LYM（×10⁹/L）							NEUT（×10⁹L）					Hb（g/L）					PLT（×10⁹/L）
非PPH组		2.15±0.48							6.24±1.06					117.36±8.42					210.18±32.15
PPH组		1.62±0.42							7.19±1.13					108.65±9.17					169.42±28.67
t		6.857^＊＊							5.322^＊＊					6.107^＊＊					7.846^＊＊

组别		n	R值/min		K值/min		α角/°
非PPH组		151	6.23±1.05		1.98±0.42		60.54±6.32
PPH组		48	6.49±1.56		2.52±0.68		58.67±5.89
t			1.100		12.397^＊＊		1.817
组别	MA值/mm			CI值		SII
非PPH组	60.31±7.09			1.25±0.36		589.42±125.68
PPH组	53.76±6.73			0.89±0.45		723.76±189.35
t	5.645^＊＊			5.660^＊＊		5.651^＊＊

组别		n	R值/min		K值/min		α角/°
非PPH组		151	6.23±1.05		1.98±0.42		60.54±6.32
PPH组		48	6.49±1.56		2.52±0.68		58.67±5.89
t			1.100		12.397^＊＊		1.817
组别	MA值/mm			CI值		SII
非PPH组	60.31±7.09			1.25±0.36		589.42±125.68
PPH组	53.76±6.73			0.89±0.45		723.76±189.35
t	5.645^＊＊			5.660^＊＊		5.651^＊＊

指标	截断值	AUC	95%CI	约登指数	特异度/%	敏感度/%
K值	2.16 min	0.706	0.604~0.795	0.373	63.83	73.47
MA值	56.31 mm	0.795	0.700~0.870	0.523	80.85	71.43
CI值	0.81	0.746	0.646~0.829	0.445	89.36	55.10
SII	771.92	0.766	0.669~0.847	0.447	95.74	48.98
联合预测	-	0.917	0.843~0.964	0.731	91.49	81.63