조기진통 임신부에서 임상적 감염의 비침습적 예측
Non-invasive prediction of clinical infection in women with preterm labor
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목적: 본 연구의 목적은 양막파수 없이 조기진통으로 입원한 임신부에서 비침습적 임상지표를 이용하여 입원 후 발생한 임신부 또는 신생아의 임상적 감염의 가능성을 예측할 수 있는 모형을 만들고자 하였다. 연구 방법: 양막파수 없는 조기진통(임신 20.0~35.0주) 임신부 165명에서 경질초음파로 자궁경부길이를 측정하였고 임신부 혈액에서 백혈구 수를 측정하였다. 임상적 감염은 임신부에서 분만 시 임상적 융모양막염이 발생하거나 혹은 신생아에서 선천성 패혈증이 발생한 경우로 정의하였다. 통계분석은 receiver operating characteristic (ROC) 곡선과 논리회귀분석을 사용하였다. 결과: 임상적 감염의 빈도는 5% (8/165)였다. 임상적 감염이 존재한 군은 존재하지 않는 군보다 입원 시 임신주수가 유의하게 낮았고, 자궁경부길이도 유의하게 짧았으나 백혈구 수는 유의하게 높았다. 논리회귀분석을 시행하여 최종 모형이 만들어 졌으며 이때 혈액 백혈구 수, 자궁경부길이, 임신주수가 가장 중요한 예측인자로 선택되었다. 이 모형은 Hosmer와 Lemeshow 검정에서 적절한 통계적합도를 보여주었으며(P=0.202), ROC 곡선에서 area under curve값은 0.822로 측정되어 유용한 예측력을 보여주었다. 결론: 양막파수 없이 조기진통으로 입원한 임신부에서 자궁경부길이, 혈액 백혈구 수, 임신주수의 임상지표를 기반으로 한 모형을 이용하면 비침습적으로 임신부 또는 신생아의 임상적 감염을 예측할 수 있다.
Abstract
Objective: To develop a model based on non-invasive variables to predict the probability of subsequent maternal and/or neonatal clinical infection in women admitted to hospital for preterm labor with intact membranes. Methods: Transvaginal ultrasound for measurement of cervical length was performed and maternal blood was collected for the determination of white blood cell (WBC) count at admission in 165 consecutive women with preterm labor (between 20.0 and 35.0 weeks). Clinical infection was defined as the presence of clinical chorioamnionitis at delivery or early onset neonatal sepsis. Receiver operating characteristic (ROC) curves and logistic regression analysis were used for statistical analyses. Results: The prevalence of clinical infection was 5% (8/165). Women who developed clinical infection had a significantly lower median gestational age at admission, a lower shorter median cervical length, and a higher median WBC count as compared to those who did not develop clinical infection. Logistic regression analysis was performed and a final model was chosen, which included maternal blood WBC, cervical length, and gestational age as the best predictors of clinical infection. A risk score was calculated containing these 3 variables for each patient. The model was shown to have an adequate goodness of fit (P=0.202), and the area under the ROC curve was 0.822, indicating reasonably good discrimination. Conclusion: In women admitted to hospital for preterm labor with intact membranes, the risk for the subsequent maternal and/or neonatal clinical infection can be predicted non-invasively with a risk score based on cervical length at admission, maternal blood WBC, and gestational age.
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