Influencing factors of postpartum lower limb deep vein thrombosis in puerpera with gestational diabetes mellitus and construction of nomogram model
10.3760/cma.j.cn115455-20230807-00091
- VernacularTitle:妊娠期糖尿病产妇发生产后下肢深静脉血栓形成的危险因素及列线图模型构建
- Author:
Qin CHEN
1
;
Xue SHEN
Author Information
1. 滕州市中心人民医院产一科，滕州 277599
- Keywords:
Diabetes, gestational;
Venous thrombosis;
Risk factors;
Nomograms
- From:
Chinese Journal of Postgraduates of Medicine
2024;47(9):808-813
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the risk factors of postpartum lower limb deep vein thrombosis (DVT) in puerpera with gestational diabetes mellitus (GDM), and to construct a nomogram model.Methods:The clinical data of 163 puerpera with GDM in Tengzhou Central People′s Hospital from January 2021 to January 2023 were analyzed retrospectively. The puerpera were followed up for 2 months, in which 78 cases had postpartum lower limb DVT (DVT group) and 85 cases did not have postpartum lower limb DVT (non-DVT group). The basic data and perinatal indexes were recorded. The serum D-dimer level was detected by immunoturbidimetry, and serum C-reactive protein (CRP) level was detected by enzyme-linked immunosorbent assay. Multivariate Logistic regression was used to analyze the independent risk factors of lower limb DVT in puerpera with GDM. R3.6.3 software and "rms" package were used to construct a nomogram model for predicting lower limb DVT in puerpera with GDM, Hosmer-Lemeshow goodness of fit test and calibration curve were applied to evaluate the consistency of nomogram model, and receiver operating characteristic (ROC) curve was used to evaluate the discrimination of model.Results:The rates of body mass index before pregnancy ≥ 25 kg/m 2, history of hypertension, caesarean section, postpartum bed rest time ≥ 2 d, postpartum poor blood glucose control, history of lower limb varicose veins and D-dimer in DVT group were significantly higher than those in non-DVT group: 44.87% (35/78) vs. 27.06% (23/85), 39.74% (31/78) vs. 18.82% (16/85), 43.59% (34/78) vs. 25.88% (22/85), 34.62% (27/78) vs. 14.12% (12/85), 44.87% (35/78) vs. 20.00% (17/85), 35.90% (28/78) vs. 16.47% (14/85) and (582.74 ± 72.42) μg/L vs. (462.39 ± 57.65) μg/L, and there were statistical differences ( P<0.05 or <0.01); there were no statistical differences in age, smoking history, drinking history, birth history, lower limb lesional side, lower limb pain, lower limb swelling and CRP between the two groups ( P>0.05). Multivariate Logistic regression analysis result showed that body mass index before pregnancy ≥25 kg/m2, history of hypertension, caesarean section, postpartum bed rest time ≥ 2 d, poor postpartum blood glucose control, history of lower limb varicose veins and high level of D-dimer were the independent risk factors of lower limb DVT in puerperal with GDM ( OR = 3.267, 3.464, 5.078, 3.346, 3.174, 6.111 and 1.027; 95% CI 1.171 to 9.273, 1.183 to 10.146, 1.737 to 14.843, 1.064 to 10.523, 1.737 to 14.843, 1.727 to 21.629 and 1.017 to 1.036; P<0.05 or <0.01). A nomogram model was constructed based on body mass index before pregnancy, history of hypertension, caesarean section, postpartum bed rest time, postpartum blood glucose control, history of lower limb varicose veins and D-dimer. The ROC curve analysis result show that the nomogram model had good discrimination (the area under the curve was 0.930, 95% CI 0.880 to 0.964). The predicted value of calibration curve was basically consistent with the actual value, and the goodness of fit test of Hosmer-Lemeshow was in good agreement ( χ2 = 10.00, P = 0.265). Conclusions:The nomogram model based on the risk factors of postpartum lower limb DVT in puerperal with GDM has good consistency and discrimination, and it can effectively predict the occurrence of postpartum lower libm DVT in puerpera with GDM.
