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Initial and Longitudinal Trajectories in Hemoglobin Levels Predict the Prognosis of Patients With Premature Rupture
Ying-Ying Chen1, Hai-Xing Huang1, Min Xiao1
1Department of Obstetrics and Gynecology, Hangzhou Linping District Maternal & Child Health Care Hospital, Hangzhou, Zhejiang, China.
Insights
Lower initial hemoglobin and declining hemoglobin levels predict longer hospital stays for patients with premature rupture of membranes (PROM). Monitoring hemoglobin is key for better PROM outcomes.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Healthcare Informatics
Background:
- Premature rupture of membranes (PROM) is associated with adverse maternal and neonatal outcomes.
- Predicting length of hospital stay (LOS) in PROM patients is crucial for optimizing management and prognosis.
Purpose of the Study:
- To identify key predictors of length of hospital stay (LOS) in patients experiencing premature rupture of membranes (PROM).
- To analyze the impact of hemoglobin level trajectories on LOS in PROM patients.
Main Methods:
- Retrospective analysis of 868 PROM patients from the MIMIC IV database.
- Utilized univariable analysis, LASSO regression, and multivariable generalized linear models (GLMs) to identify LOS predictors.
- Employed latent class trajectory modeling (LCTM) to analyze hemoglobin level trends and their association with LOS.
Main Results:
- Initial hemoglobin, chorioamnionitis, premature birth, and rupture-to-delivery interval <24 hours were significant factors influencing LOS.
- Higher initial hemoglobin levels were independently associated with shorter LOS (β = -0.599, p < 0.05).
- The "lowest, declining" hemoglobin trajectory group experienced significantly longer LOS compared to other groups (p < 0.05).
Conclusions:
- Lower initial hemoglobin levels and a "lowest, declining" hemoglobin trajectory are linked to prolonged LOS in PROM patients.
- Active monitoring and management of hemoglobin levels are essential for improving patient outcomes in PROM cases.
Problem:
Premature rupture of membranes (PROM) can lead to adverse maternal and neonatal outcomes. Identifying predictors of length of hospital stay (LOS) in PROM patients can aid in improving management and prognosis.
Method Of Study:
The Medical Information Mart for Intensive Care IV database was searched to acquire data on PROM individuals. A univariable analysis, LASSO regression, and multivariable generalized linear model (GLM) were adopted to identify factors closely related to LOS. Next, the change trends in the key variable over multiple time points were determined using a latent class trajectory model (LCTM). The association of these trajectories with LOS was analyzed using GLMs.
Results:
The retrospective study finally enrolled 868 samples. The significant factors included initial hemoglobin, chorioamnionitis, premature birth, and rupture to delivery interval <24 h. Notably, higher initial hemoglobin level was independently associated with shorter LOS (β = -0.599; 95% CI = [-0.846, -0.352]; p < 0.05). The stratified analysis confirmed this association in all subgroups except those with chorioamnionitis. The LCTM identified three hemoglobin trajectories. Compared to other trajectory groups, the "lowest, declining" group had longer LOS (p < 0.05).
Conclusions:
PROM patients with lower initial hemoglobin levels and the "lowest, declining" trajectory group were linked to longer LOS. Monitoring and managing hemoglobin levels is important in improving patient outcomes.
