Multivariable risk model for postpartum re-presentation with hypertension: development phase.

Autor:	McDougall HE; Alfred Health, Melbourne, Victoria, Australia h.mcdougall@alfred.org.au.; Northern Health, Melbourne, Victoria, Australia., Yuan G; Northern Health, Melbourne, Victoria, Australia.; The University of Melbourne, Parkville, Victoria, Australia., Olivier N; Northern Health, Melbourne, Victoria, Australia., Tacey M; Northern Health, Melbourne, Victoria, Australia.; Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia., Langsford D; The University of Melbourne, Parkville, Victoria, Australia.; Grampians Health, Ballarat, Victoria, Australia.
Jazyk:	angličtina
Zdroj:	BMJ open quality [BMJ Open Qual] 2023 Dec 28; Vol. 12 (4). Date of Electronic Publication: 2023 Dec 28.
DOI:	10.1136/bmjoq-2022-002212
Abstrakt:	Objectives: Postpartum hypertension is one of the leading causes of re-presentation to hospital postpartum and is associated with adverse long-term cardiovascular risk. Postpartum blood pressure monitoring and management interventions have been shown to reduce hospital re-presentation, complications and long-term blood pressure control. Identifying patients at risk can be difficult as 40%-50% present with de novo postpartum hypertension. We aim to develop a risk model for postpartum re-presentation with hypertension using data readily available at the point of discharge. Design: A case-control study comparing all patients who re-presented to hospital with hypertension within 28 days post partum to a random sample of all deliveries who did not re-present with hypertension. Multivariable analysis identified risk factors and bootstrapping selected variables for inclusion in the model. The area under the receiver operator characteristic curve or C-statistic was used to test the model's discriminative ability. Setting: A retrospective review of all deliveries at a tertiary metropolitan hospital in Melbourne, Australia from 1 January 2016 to 30 December 2020. Results: There were 17 746 deliveries, 72 hypertension re-presentations of which 51.4% presented with de novo postpartum hypertension. 15 variables were considered for the multivariable model. We estimated a maximum of seven factors could be included to avoid overfitting. Bootstrapping selected six factors including pre-eclampsia, gestational hypertension, peak systolic blood pressure in the delivery admission, aspirin prescription and elective caesarean delivery with a C-statistic of 0.90 in a training cohort. Conclusion: The development phase of this risk model builds on the three previously published models and uses factors readily available at the point of delivery admission discharge. Once tested in a validation cohort, this model could be used to identify at risk women for interventions to help prevent hypertension re-presentation and the short-term and long-term complications of postpartum hypertension. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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