Establishment and validation of a predictive model for perioperative heart failure in patients with hypertensive disorders in pregnancy (HDP)

Abstract Objective: The aim of this study is to create and validate a model that predicts the risk of perioperative heart failure for individuals who have hypertensive disorders in pregnancy (HDP). Material and methods: We investigated a retrospective cohort of females with HDP who had caesarean sections performed at our hospital between January 1, 2014, and June 31, 2021. Exclusion criteria comprised under 18 years of age, incomplete clinical data, natural vaginal delivery, and complications with heart disease. The investigation's cohort was separated into two groups at random; 75% of pregnancies were allocated for the development of a prediction model, while the remaining 25% was employed for internal validation of the model. The predictors included in this study were those associated with heart failure and risk factors for hypertensive disorders in pregnancy. The most parsimonious model of perioperative heart failure was generated by employing stepwise backwards logistic regression. Goodness-of-fit was evaluated utilizing the Hosmer‒Lemeshow test. The assessment of model discrimination was performed employing the concordance index, and the area under the receiver operating characteristic curve (AUC) was utilized for illustration. Results: In this study, predictive models were developed and validated to predict the probability of perioperative heart failure in patients with HDP. The model includes 4 predictive factors, such as preoperative HELLP syndrome, MAP, American Society of Anesthesiologists (ASA) classification, and anaesthesia method, which can unite preoperative comorbidities and intraoperative conditions to predict the probability of perioperative heart failure in patients with HDP. The model concordance index was 0.8501, with good discrimination and calibration, a high predictive value, and clinical utility. Conclusion: The predictive model for perioperative heart failure in patients with hypertensive disorders in pregnancy (HDP) is helpful for anaesthesiologists to formulate personalized and precise treatment plans for caesarean section in patients with hypertension in pregnancy, which has important clinical significance.