| BackgroudPreeclampsia(PE)is a multisystemic pregnancy disorder that affects an estimated 2-8%of pregnancies worldwide.Globally,there is a gradual increase in the incidence of pre-eclampsia due to the gradual increase in advanced maternal age,the improvement in people’s standard of living and the change in diet structure.PE is one of the leading causes of maternal and neonatal morbidity and mortality.PE is divided into two subtypes mainly based on its occurrence before or after 34 weeks:early-onset preeclampsia and late-onset preeclampsia.Early-onset preeclampsia can lead to more serious complications for mother and fetus than the late-onset preeclampsia.Current treatment options for PE during pregnancy include antihypertensive,antispasmodic and sedative therapy.Human albumin is often used in intensive care units,in patients with cirrhosis,in patients with burns,and to prevent acute kidney injury.Commonly used in obstetrics as an adjunctive therapy for patients with EOPE hypoproteinemia.However,its use in the management of patients with EOPE hypoproteinemia has been controversial,and there is a lack of relevant clinical studies to confirm its effect on maternal and neonatal outcomes in EOPE patients.ObjectiveTo compare the differences of maternal and neonatal clinical characteristics and outcomes between PE patients with and without intravenous albumin treatment groups,and further investigate the effect of intravenous albumin infusion on maternal and neonatal outcomes in EOPE patients.MethodsEOPE patients who delivered at Qilu Hospital of Shandong University from March 2017 to July 2020 were collected.The group was divided into albumin-treated and non-albumin-treated groups according to whether they were treated with albumin before delivery.Univariate and multifactorial logistic regression analysis was used to screen for clinical factors that might be associated with albumin therapy using intravenous albumin infusion as an outcome.The propensity score matching(PSM)algorithm was used to match the two groups of patients 1:1 to balance the differences in clinical characteristics between the albumin-treated and non-albumin-treated groups.The differences in clinical characteristics between the two groups of patients before and after matching were analyzed using the chi-square test as well as the nonparametric rank sum test.Finally,with maternal and neonatal adverse events respectively.Finally,univariate and multifactorial logistic regression analyses were used to assess the risk factors associated with adverse events in EOPE patients and neonates,using maternal adverse events as the outcome and neonatal adverse events as the outcome,respectively.ResultsA total of 423 patients with EOPE were included in this study,and 143 in the albumin-treated group and 280 in the non-albumin-treated group.In the pre-matched cohort,the albumin-treated group was compared with the non-albumin-treated group in terms of dizziness and headache symptoms(p=0.018),ascites(p<0.001),pleural effusion(p<0.001),chronic hypertension(p=0.040),platelets(p=0.025),glutathione(p=0.048),glutathione(p=0.017),creatinine(p<0.001),blood urea nitrogen(p=0.004),total protein(p<0.001),albumin(p<0.001),urine protein(p<0.001),umbilical artery flow spectrum S/D ratio(p=0.017),and week of gestation of admission(p<0.001)were different.There were no statistically significant differences in age,number of deliveries,body mass index,use of assisted reproductive technology,blurred vision,breathholding,use of aspirin and low molecular heparin in early and mid-term pregnancy,blood pressure,gestational diabetes,autoimmune disease,cardiovascular disease,thyroid function,neutrophil to lymphocyte ratio,platelet to lymphocyte ratio,and hemoglobin between the two groups(p>0.05).After PSM 1:1 matching,there were 98 patients in the albumin-treated group and 98 patients in the non-albumin-treated group in the matched cohort.there was no significant difference in the basic clinical characteristics before delivery in the PSMmatched cohort(p>0.05).In the post-matching cohort,Patients in the albumin-treated group had a greater rate of heart failure than those in the non-albumin-treated group(7.1%vs.1.0%,p=0.030).The length of the hospitalization was longer in the albumin-treated group than in the non-albumin-treated group(11 days vs.10 days,p=0.02),and the length of stay before delivery was longer in the albumin group than in the non-albumin-treated group(6 days vs.5 days,p<0.001),with statistically significant differences.Statistical analysis of neonatal perinatal outcomes in the post-matching cohort showed that the probability of intrauterine distress was less in the albumin-treated group than in the non-albumin-treated group(14.3%vs.25.5%,p=0.049).U In the analysis of risk factors for adverse maternal outcomes,a univariate logistic regression analysis of the basic clinical characteristics of the matched cohort of EOPE patients screened 14 high-risk factors that could be associated with adverse maternal pregnancy outcomes(p<0.250):body mass index,blurred vision,breathholding,maximum systolic blood pressure,chronic hypertension,cardiovascular disease,neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,hemoglobin,platelets,ghrelin,ghrelin,mode of delivery,and week of delivery.The 14 associated risk factors screened by univariate logistic regression analysis associated with poor maternal pregnancy outcome were entered into a multifactorial logistic regression analysis,and three independent risk factors associated with poor maternal pregnancy outcome were found to include:cardiovascular disease(OR 5.44,95%CI 1.53-19.31,p=0.011),NLR(OR 1.18,95%CI 1.03-1.35,p=0.01),and PLT(OR 0.99,95%CI 0.991.00,p=0.008).Termination of pregnancy by cesarean delivery(OR 0.008,95%CI 0.01-1.93,p=0.044)was a protective factor for patients with EOPE.The 14 risk factors associated with adverse maternal pregnancy outcomes screened by univariate logistic regression analysis were entered into a multifactorial logistic regression analysis,which identified four high-risk factors associated with adverse maternal pregnancy outcomes:cardiovascular disease(ratio[odds ratio,OR]5.44,95%confidence intervals[CI]1.5319.31,p=p=0.009),platelet to lymphocyte ratio(OR 1.18,95%CI 1.04-1.37,p=0.010),platelets(OR 0.99,95%CI 0.99-1.00,p=0.008),termination of pregnancy by cesarean section(OR 0.08,95%CI 0.01-0.93,p=0.044).In the analysis of risk factors for adverse neonatal outcomes,a univariate logistic regression analysis of the basic clinical characteristics of the matched cohort of EOPE patients screened 11 high-risk factors(p<0.250):age,pleural effusion,pericardial effusion,gestational diabetes,autoimmune disease,platelet to lymphocyte ratio,hemoglobin,ghrelin,glutamic transaminase,glutamic oxaloacetic transaminase,creatinine,umbilical artery blood flow spectrum S/D ratio,gestational week of delivery.Eleven risk factors associated with adverse perinatal outcomes in newborns screened by univariate logistic regression analysis and entered into multivariate logistic regression analysis revealed that the highest risk factor associated with adverse perinatal outcomes in newborns was delivery at<32 weeks gestational week(OR 2.65,95%CI 1.23-6.16,p=0.015).Conclusions1.The rate of intrauterine distress was lower in the EOPE patients in the intravenous albumin treatment group,but the total length of hospitalization and length of hospitalization before delivery were significantly higher than in the non-intravenous albumin treatment group.2.Combined cardiovascular disease,high neutrophil-to-lymphocyte ratio,and low platelet count in EOPE patients are risk factors for adverse maternal pregnancy outcomes. |
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