NEO-LUPUS: Transparent Autoimmune Congenital Heart Block Risk-Context Stratification in Anti-Ro/SSA Pregnancies

Executable Code

#!/usr/bin/env python3
"""NEO-LUPUS: transparent autoimmune congenital heart block risk-context stratification.

Authors: Dr. Erick Zamora-Tehozol (ORCID: 0000-0002-7888-3961), DNAI, RheumaAI
License: MIT
"""
from __future__ import annotations

from dataclasses import dataclass, asdict
from typing import Any, Dict, List, Optional


@dataclass
class NeoLupusInput:
    label: str
    anti_ro_positive: bool = True
    anti_ro52_high_titer: bool = False
    anti_ro60_high_titer: bool = False
    anti_la_positive: bool = False
    prior_child_with_chb: bool = False
    prior_neonatal_lupus: bool = False
    maternal_sle_or_sjogren_active: bool = False
    hydroxychloroquine: bool = False
    hcq_adherent: bool = False
    gestational_weeks: float = 0.0
    fetal_echo_days_since_last: Optional[float] = None
    fetal_pr_interval_ms: Optional[float] = None
    fetal_bradycardia: bool = False
    second_or_third_degree_block: bool = False
    fetal_hydrops: bool = False
    maternal_steroids: bool = False


def clamp(x: float, lo: float = 0.0, hi: float = 100.0) -> float:
    return max(lo, min(hi, x))


def score_neo_lupus(p: NeoLupusInput) -> Dict[str, Any]:
    c: Dict[str, int] = {}
    c["anti_ro_positive"] = 12 if p.anti_ro_positive else 0
    c["anti_ro52_high_titer"] = 10 if p.anti_ro52_high_titer else 0
    c["anti_ro60_high_titer"] = 4 if p.anti_ro60_high_titer else 0
    c["anti_la_positive"] = 4 if p.anti_la_positive else 0
    c["prior_child_with_chb"] = 28 if p.prior_child_with_chb else 0
    c["prior_neonatal_lupus"] = 10 if p.prior_neonatal_lupus else 0
    c["maternal_active_autoimmunity"] = 6 if p.maternal_sle_or_sjogren_active else 0

    if 16 <= p.gestational_weeks <= 26:
        c["critical_window"] = 8
    elif 14 <= p.gestational_weeks < 16 or 26 < p.gestational_weeks <= 28:
        c["critical_window"] = 4
    else:
        c["critical_window"] = 0

    if p.fetal_echo_days_since_last is None:
        c["echo_gap"] = 4 if 16 <= p.gestational_weeks <= 26 else 0
    elif p.fetal_echo_days_since_last >= 14:
        c["echo_gap"] = 8
    elif p.fetal_echo_days_since_last >= 7:
        c["echo_gap"] = 4
    else:
        c["echo_gap"] = 0

    if p.fetal_pr_interval_ms is not None:
        if p.fetal_pr_interval_ms >= 150:
            c["fetal_pr"] = 18
        elif p.fetal_pr_interval_ms >= 140:
            c["fetal_pr"] = 10
        elif p.fetal_pr_interval_ms >= 130:
            c["fetal_pr"] = 4
        else:
            c["fetal_pr"] = 0
    else:
        c["fetal_pr"] = 0

    c["fetal_bradycardia"] = 16 if p.fetal_bradycardia else 0
    c["block"] = 30 if p.second_or_third_degree_block else 0
    c["hydrops"] = 12 if p.fetal_hydrops else 0
    c["maternal_steroids"] = 4 if p.maternal_steroids else 0

    if p.hydroxychloroquine:
        c["hcq_protection"] = -8 if p.hcq_adherent else -3
    else:
        c["hcq_protection"] = 0

    raw = sum(c.values())
    score = round(clamp(float(raw)), 1)

    red_flag = p.second_or_third_degree_block or (p.fetal_bradycardia and p.fetal_pr_interval_ms is not None and p.fetal_pr_interval_ms >= 150)
    if red_flag:
        category = "CRITICAL CHB concern"
    elif score >= 65:
        category = "VERY HIGH CHB concern"
    elif score >= 40:
        category = "HIGH CHB concern"
    elif score >= 20:
        category = "INTERMEDIATE CHB concern"
    else:
        category = "LOW CHB concern"

    if red_flag:
        recommendation = (
            "Urgent maternal-fetal medicine and fetal cardiology review now; confirm block severity, repeat fetal rhythm assessment, "
            "and treat this as a time-sensitive autoimmune fetal conduction emergency."
        )
    elif score >= 65:
        recommendation = (
            "Very high-risk anti-Ro pregnancy. Ensure hydroxychloroquine if appropriate, tighten fetal echo surveillance, and avoid delays in fetal cardiology review."
        )
    elif score >= 40:
        recommendation = (
            "High-risk anti-Ro/SSA pregnancy. Confirm antibody profile, document fetal rhythm baseline, and maintain close surveillance during the 16-26 week window."
        )
    elif score >= 20:
        recommendation = (
            "Intermediate risk. Continue structured fetal monitoring and optimize maternal autoimmune control, especially if the pregnancy is in the conduction-risk window."
        )
    else:
        recommendation = "Low current CHB concern, but anti-Ro pregnancies still need routine surveillance according to local protocol."

    actions: List[str] = []
    if p.prior_child_with_chb:
        actions.append("Prior affected pregnancy markedly increases recurrence risk")
    if p.hydroxychloroquine and p.hcq_adherent:
        actions.append("Hydroxychloroquine is the main preventive therapy signal in this setting")
    if 16 <= p.gestational_weeks <= 26:
        actions.append("This is the peak surveillance window for autoimmune fetal conduction disease")
    if p.fetal_echo_days_since_last is not None and p.fetal_echo_days_since_last >= 7:
        actions.append("Echo interval is long enough to miss rapid conduction change")
    if p.fetal_pr_interval_ms is not None and p.fetal_pr_interval_ms >= 130:
        actions.append("First-degree conduction delay should not be ignored in anti-Ro pregnancy")

    return {
        "label": p.label,
        "score": score,
        "category": category,
        "red_flag": red_flag,
        "components": c,
        "actions": actions,
        "recommendation": recommendation,
        "input": asdict(p),
    }


def demo() -> List[Dict[str, Any]]:
    cases = [
        NeoLupusInput(
            label="Anti-Ro positive pregnancy on HCQ, no prior affected child, normal surveillance",
            anti_ro_positive=True,
            anti_ro52_high_titer=False,
            anti_ro60_high_titer=False,
            anti_la_positive=False,
            prior_child_with_chb=False,
            prior_neonatal_lupus=False,
            maternal_sle_or_sjogren_active=False,
            hydroxychloroquine=True,
            hcq_adherent=True,
            gestational_weeks=18,
            fetal_echo_days_since_last=6,
            fetal_pr_interval_ms=118,
        ),
        NeoLupusInput(
            label="High-risk anti-Ro/La pregnancy with prior neonatal lupus and delayed echo",
            anti_ro_positive=True,
            anti_ro52_high_titer=True,
            anti_ro60_high_titer=True,
            anti_la_positive=True,
            prior_child_with_chb=False,
            prior_neonatal_lupus=True,
            maternal_sle_or_sjogren_active=True,
            hydroxychloroquine=False,
            hcq_adherent=False,
            gestational_weeks=21,
            fetal_echo_days_since_last=14,
            fetal_pr_interval_ms=138,
        ),
        NeoLupusInput(
            label="Recurrent CHB pregnancy with fetal bradycardia and second-degree block",
            anti_ro_positive=True,
            anti_ro52_high_titer=True,
            anti_ro60_high_titer=True,
            anti_la_positive=True,
            prior_child_with_chb=True,
            prior_neonatal_lupus=True,
            maternal_sle_or_sjogren_active=True,
            hydroxychloroquine=True,
            hcq_adherent=False,
            gestational_weeks=23,
            fetal_echo_days_since_last=8,
            fetal_pr_interval_ms=155,
            fetal_bradycardia=True,
            second_or_third_degree_block=True,
            fetal_hydrops=False,
            maternal_steroids=True,
        ),
    ]
    return [score_neo_lupus(c) for c in cases]


if __name__ == "__main__":
    print("=" * 78)
    print("NEO-LUPUS: Autoimmune Congenital Heart Block Risk-Context Stratification")
    print("=" * 78)
    for r in demo():
        print(f"\n{r['label']}")
        print(f"  Score: {r['score']}")
        print(f"  Category: {r['category']}")
        print(f"  Recommendation: {r['recommendation']}")
        if r['actions']:
            print("  Actions:")
            for a in r['actions']:
                print(f"    - {a}")
    print("\nReferences:")
    print("  1. Hydroxychloroquine to Prevent Recurrent Congenital Heart Block in Fetuses of Anti-SSA/Ro-Positive Mothers. J Am Coll Cardiol. 2020. DOI: 10.1016/j.jacc.2020.05.045")
    print("  2. Autoimmune Congenital Heart Block: A Review of Biomarkers and Novel Therapies. Front Pediatr. 2020. DOI: 10.3389/fped.2020.607515")
    print("  3. Autoimmune congenital heart block: a case report and review of the literature. Arthritis Res Ther. 2023. DOI: 10.1186/s13075-023-03246-w")
    print("=" * 78)

Demo Output

Anti-Ro positive pregnancy on HCQ, no prior affected child, normal surveillance -> LOW
High-risk anti-Ro/La pregnancy with prior neonatal lupus and delayed echo -> VERY HIGH
Recurrent CHB pregnancy with fetal bradycardia and second-degree block -> CRITICAL