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A risk prediction model for medical treatment failure in tubal pregnancy

 Jae Hoon Lee  ;  Sunghoon Kim  ;  Inha Lee  ;  Jisun Yun  ;  Bo Hyon Yun  ;  Young Sik Choi  ;  Byung Seok Lee  ;  Seok Kyo Seo 
 European Journal of Obstetrics & Gynecology and Reproductive Biology, Vol.225 : 148-154, 2018 
Journal Title
 European Journal of Obstetrics & Gynecology and Reproductive Biology 
Issue Date
Medical treatment failure ; Methotrexate treatment ; Risk prediction model ; Tubal pregnancy
OBJECTIVE: Methotrexate is an alternative treatment for tubal pregnancy. However, despite initial treatment, approximately 15% of women eventually require surgery. This study aimed to identify the risk factors for medical treatment failure in tubal pregnancy and apply them to a risk prediction model. STUDY DESIGN: This single-center retrospective cohort study included 123 participants initially treated medically for tubal pregnancy between January 2006 and December 2015. Logistic regression analysis was used to construct a risk prediction model (visually presented as a nomogram) for medical treatment failure. Model performance was assessed using discrimination and calibration. The medical treatment failure rate was 36.6%. The prediction model integrated the presence of a gestational sac, ectopic mass size, and follow-up beta-human chorionic gonadotropin levels above cut-off values on days 4 and 7. The model used the following cut-off values: increased beta-human chorionic gonadotropin levels by 1028.6 mIU/mL, 1.0457-fold higher than baseline level on day 4; and increased beta-human chorionic gonadotropin levels by 1233 mIU/mL, 1.3025-fold higher than baseline level on day 7. RESULTS: The corresponding areas under the receiver-operating characteristic curves were 0.8135 (95% confidence interval, 0.733-0.893) for the day 4 model and 0.8600 for the day 7 model (95% confidence interval, 0.788-0.932). Comparison of the day 4 and 7 models revealed no significant difference in their predictive abilities (P=0.4318). CONCLUSIONS: This model identified a substantial proportion of the participants who experienced medical treatment failure for tubal pregnancy. It was visualized as a nomogram, facilitating clinical application.
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Obstetrics and Gynecology (산부인과학교실)
Yonsei Authors
김성훈(Kim, Sung Hoon) ORCID logo https://orcid.org/0000-0002-1645-7473
서석교(Seo, Seok Kyo) ORCID logo https://orcid.org/0000-0003-3404-0484
윤보현(Yun, Bo Hyon) ORCID logo https://orcid.org/0000-0001-5703-797X
윤지선(Yun, Jisun)
이병석(Lee, Byung Seok)
이인하(Lee, Inha) ORCID logo https://orcid.org/0000-0003-4869-6281
이재훈(Lee, Jae Hoon)
최영식(Choi, Young Sik) ORCID logo https://orcid.org/0000-0002-1157-4822
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