Work

Development and validation of a prediction model for hypotension after neuraxial anesthesia in preeclamptic parturients: a multicenter retrospective study

Year: 2025

Type: article

Abstract: Objective To develop and validate a multivariate prediction model for hypotension following neuraxial anesthesia in preeclamptic parturients. Methods This multicenter retrospective study analyzed 1,402 preeclamptic parturients (gestational age ≥28 weeks) from three tertiary centers (2013–2024). After exclusions (n = 569), 833 patients were allocated to training (n = 495), internal validation (n = 213), and external validation (n = 125) cohorts. Multivariable logistic regression identified independent predictors, with subsequent nomogram construction. Model performance was assessed via discrimination (AUC), calibration (Hosmer-Lemeshow), and clinical utility [decision curve analysis (DCA), clinical impact curves (CIC)]. Results Seven independent predictors were identified: platelet count (OR 0.920, 95%CI 0.876–0.966), sFlt-1/PlGF ratio (OR 1.039, 95%CI 1.002–1.078), baseline perfusion index (OR 0.221, 95%CI 0.101–0.485), T6 anesthesia level (OR 11.353, 95%CI 1.408–29.320), local anesthetic dose (OR 29.391, 95%CI 4.792–38.270), fetal weight (OR 1.004, p = 0.045), and umbilical artery S/D ratio (OR 9.319, p < 0.001). The nomogram demonstrated robust discrimination (training AUC 0.851; internal validation AUC 0.836; external validation AUC 0.810) and calibration (mean absolute errors: 0.013–0.038). DCA confirmed clinical utility at a 45% risk threshold (net benefit 0.62), capturing 85% of events with 32% false positives. Conclusion This validated prediction model accurately stratifies hypotension risk in preeclamptic parturients receiving neuraxial anesthesia. The nomogram facilitates targeted prophylactic interventions, optimizing resource allocation and maternal hemodynamic stability.

Source: Frontiers in Medicine

DOI: 10.3389/fmed.2025.1649657

Authors: Jie Su, Qumin Chen, Xiuhong Ye, Huan Lu

Institutions: Xiamen University, First Affiliated Hospital of Xiamen University, Fujian Medical University, Fujian Women and Children Hospital

Language: English

Topic: Pregnancy and preeclampsia studies

Subfield: Obstetrics and Gynecology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801