Abstract
To identify the factors affecting adverse reproductive outcomes in TPOAb-positive patients and to establish a predictive model based on these factors to assess the risk of adverse reproductive outcomes in patients. A retrospective cohort study was conducted, including 326 TPOAb-positive female patients who visited the reproductive medicine clinic of our hospital from January 2020 to December 2022. Patients were divided into groups with adverse reproductive outcomes and without adverse reproductive outcomes based on clinical outcomes. Data analysis was performed using SPSS software version 26.0 and R software, and independent risk factors for adverse reproductive outcomes were identified through univariate and multivariate logistic regression analysis, followed by the construction of a nomogram predictive model. The predictive performance of the model was assessed using the ROC curve. Additionally, a subgroup analysis was conducted within the adverse reproductive outcomes group. Logistic regression analyses were performed for the three subgroups: recurrent miscarriage, repeated implantation failure, and no usable embryos, to explore specific risk factors for each subgroup and compare the performance of predictive models for each subgroup. Univariate analysis showed that age, AMH levels, TPOAb concentration, TSH levels, and endometriosis are significant factors affecting adverse reproductive outcomes (P < 0.05). Multivariate logistic regression analysis further confirmed these factors as independent risk factors for adverse reproductive outcomes. The established nomogram predictive model showed good predictive performance in both the training set (AUC = 0.901) and the validation set (AUC = 0.858). Subgroup analysis showed that TSH levels, TPOAb concentration, age, AMH levels, and endometriosis were common risk factors for the three groups, but their weights differed. The nomogram model demonstrated the best predictive performance in the RIF group (AUC = 0.926), while its predictive performance was relatively lower in the RPL group (AUC = 0.869). This study successfully established a nomogram predictive model for adverse reproductive outcomes in TPOAb-positive patients. Through subgroup analysis, we identified the specific risk factors and predictive performance for subgroups of recurrent miscarriage, repeated implantation failure, and unavailable embryos, providing a reference for precise clinical assessment and intervention.