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- Title
External validation of a simple risk score based on the ASPRE trial algorithm for preterm pre-eclampsia considering maternal characteristics in nulliparous pregnant women: a multicentre retrospective cohort study.
- Authors
Brunelli, E; Seidenari, A; Germano, C; Prefumo, F; Cavoretto, P; Di Martino, D; Masturzo, B; Morano, D; Rizzo, N; Farina, A
- Abstract
<bold>Objective: </bold>To validate the performance of a first-trimester simple risk score based on the ASPRE trial algorithm for pre-eclampsia.<bold>Design: </bold>Multicentre retrospective cohort analysis.<bold>Setting: </bold>Four Italian hospitals.<bold>Population: </bold>Unselected nulliparous women at 11-13 weeks of gestation from January 2014 through to January 2018.<bold>Methods: </bold>Model performance was evaluated based on discrimination and calibration.<bold>Main Outcome Measures: </bold>Delivery before 37 weeks of gestation with a diagnosis of pre-eclampsia.<bold>Results: </bold>Based on 73 preterm pre-eclampsia cases and 7546 controls (including 101 cases of late pre-eclampsia), the area under the receiver operating characteristics curve was 0.659 (95% CI 0.579-0.726). The sensitivity was 32.9% (95% CI 22.1-43.7) at a false-positive rate of 8.8%. The positive likelihood ratio was 3.74 (95% CI 2.67-5.23), the positive predictive value was 3.49% (95% CI 2.12-4.86%) and the negative predictive value was 99.3% (95% CI 99.1-99.5%). The sensitivity and positive likelihood ratio were approximately 40% lower than in the original study. The calibration analysis showed a good agreement between observed and expected risks (P = 0.037). Comparison with the Fetal Medicine Foundation (FMF) algorithm yielded a difference in the area under the curve of 0.084 (P = 0.007).<bold>Conclusions: </bold>In our Italian population, the simple risk score had a lower performance than expected for the prediction of preterm pre-eclampsia in nulliparous women. The FMF algorithm applied to the same data set resulted in a better prediction.<bold>Tweetable Abstract: </bold>Simple risk score predicts preterm pre-eclampsia in Italy.
- Subjects
ITALY; PREGNANT women; PREECLAMPSIA; ALGORITHMS; RECEIVER operating characteristic curves; OBSTETRICS; PREECLAMPSIA diagnosis; RESEARCH; PREDICTIVE tests; FIRST trimester of pregnancy; RESEARCH methodology; RETROSPECTIVE studies; CASE-control method; EVALUATION research; MEDICAL cooperation; RISK assessment; COMPARATIVE studies; EARLY diagnosis; STANDARDS
- Publication
BJOG: An International Journal of Obstetrics & Gynaecology, 2020, Vol 127, Issue 10, p1210
- ISSN
1470-0328
- Publication type
journal article
- DOI
10.1111/1471-0528.16246