Angiogenic factors combined with clinical risk factors to predict preterm pre‐eclampsia in nulliparous women: a predictive test accuracy study

BJOG: An International Journal of Obstetrics and Gynaecology - Tập 120 Số 10 - Trang 1215-1223 - 2013
Jenny Myers1, Louise C. Kenny2, Lesley McCowan3, EHY Chan3, GA Dekker4, Lucilla Poston5, Nab Simpson6, R A North5
1Faculty of Medical and Human Sciences Maternal & Fetal Heath Research Centre Institute of Human Development Manchester Academic Health Science Centre Central Manchester University Hospitals NHS Foundation Trust University of Manchester Manchester UK
2Department of Obstetrics & Gynaecology University College Cork Cork Ireland
3Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
4Women's and Children's Division Lyell McEwin Hospital Robinson Institute University of Adelaide Adelaide SA Australia
5Division of Women’s Health, King’s College London and King’s Health Partners, London, UK
6Department of Obstetrics and Gynaecology, University of Leeds, Leeds, UK

Tóm tắt

ObjectivesTo assess the performance of clinical risk factors, uterine artery Doppler and angiogenic markers to predict preterm pre‐eclampsia in nulliparous women.DesignPredictive test accuracy study.SettingProspective multicentre cohort study Screening for Pregnancy Endpoints (SCOPE).MethodsLow‐risk nulliparous women with a singleton pregnancy were recruited. Clinical risk factor data were obtained and plasma placental growth factor (PlGF), soluble endoglin and soluble fms‐like tyrosine kinase‐1 (sFlt‐1) were measured at 14–16 weeks of gestation. Prediction models were developed using multivariable stepwise logistic regression.Main outcome measurePreterm pre‐eclampsia (delivered before 37+0 weeks of gestation).ResultsOf the 3529 women recruited, 187 (5.3%) developed pre‐eclampsia of whom 47 (1.3%) delivered preterm. Controls (n = 188) were randomly selected from women without preterm pre‐eclampsia and included women who developed other pregnancy complications. An area under a receiver operating characteristic curve (AUC) of 0.76 (95% CI 0.67–0.84) was observed using previously reported clinical risk variables. The AUC improved following the addition of PlGF measured at 14–16 weeks (0.84; 95% CI 0.77–0.91), but no further improvement was observed with the addition of uterine artery Doppler or the other angiogenic markers. A sensitivity of 45% (95% CI 0.31–0.59) (5% false‐positive rate) and post‐test probability of 11% (95% CI 9–13) were observed using clinical risk variables and PlGF measurement.ConclusionsAddition of plasma PlGF at 14–16 weeks of gestation to clinical risk assessment improved the identification of nulliparous women at increased risk of developing preterm pre‐eclampsia, but the performance is not sufficient to warrant introduction as a clinical screening test. These findings are marker dependent, not assay dependent; additional markers are needed to achieve clinical utility.

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Tài liệu tham khảo

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Thông tin
Thông tin xuất bản

BJOG: An International Journal of Obstetrics and Gynaecology

Tập 120 Số 10

1215-1223

Thông tin tác giả