Assessment of Risk Factors Associated with Severe Endometriosis and Establishment of Preoperative Prediction Model

Abstract

Approximately 10% (176 million) of women of reproductive age worldwide suffer from endometriosis, which has a high rate of postoperative recurrence. The objective of this study was to investigate the risk factors of severe endometriosis and establish a preoperative prediction model. A retrospective analysis of a database established between January 2020 and March 2022 including 491 women with a pathology-based endometriosis diagnosis was conducted. Subjects were divided into two groups: the non-severe group (ASRM ≤ 40) and the severe group (ASRM > 40). Age ≥ 40 years, bilateral lesions, pelvic nodules, adenomyosis, APTT, CA125 ≥ 34.5 U/mL, D-dimer ≥ 0.34 mg/L, and maximum cyst diameter ≥ 58 mm were independent correlation factors for severe endometriosis. The logistic regression equation for these factors showed good diagnostic efficiency (AUC = 0.846), which was similar to the model with intraoperative indicators (AUC = 0.865). Patients with severe endometriosis also had a shorter APTT and higher D-dimer and PLT, indicating hypercoagulability. In conclusion, we constructed a simple and feasible formula involving parameters that are preoperatively accessible to predict the severity of endometriosis. This study is of reference value for determining the timing of and alternatives to surgery. At the same time, attention should be paid to the primary prevention of venous thrombosis and cardiovascular metabolic diseases in patients with severe endometriosis.