Kuhrt K, Hezelgrave N, Foster C, Seed P T, Shennan A H
Woman's Health Academic Centre, King's College London, London, UK.
Ultrasound Obstet Gynecol. 2016 Feb;47(2):210-6. doi: 10.1002/uog.14894.
To develop a reliable and validated tool for prediction of spontaneous preterm birth (sPTB) in symptomatic women that incorporates quantitative measurements of fetal fibronectin (qfFN) and other relevant risk factors.
Data were analyzed that had been collected prospectively from 382 women who presented at an emergency assessment unit between 22 + 0 and 35 + 6 weeks' gestation with symptoms of preterm labor. Clinicians were blinded to qfFN although they were aware of qualitative fFN results. Parametric survival models for sPTB, with time-updated covariates, were developed for combinations of predictors and the best was selected using the Akaike and Bayesian information criteria. The model was developed on the first 190 consecutive women and validated on the subsequent 192. The estimated probability of delivery before 30, 34 or 37 weeks' gestation and within 2 or 4 weeks of testing was calculated for each patient and was compared to actual event rates. Predictive statistics were calculated to compare training and validation sets.
The final model that was selected used qfFN and previous sPTB/preterm prelabor rupture of membranes (PPROM) as predictors. Predictive statistics were similar for training and validation sets and there was good agreement between expected and observed sPTB for all outcomes. Areas under the receiver-operating characteristics curves ranged from 0.77 to 0.88, indicating accurate prediction across all five delivery outcomes.
sPTB in symptomatic women can be predicted accurately using a model combining qfFN and previous sPTB/PPROM. Clinicians can use this model, which has been incorporated into an App (QUiPP), to determine accurately a woman's risk of sPTB and potentially tailor management decisions appropriately.
开发一种可靠且经过验证的工具，用于预测有症状女性的自发性早产（sPTB），该工具纳入了胎儿纤连蛋白（qfFN）的定量测量及其他相关风险因素。
对前瞻性收集的382例妊娠22 + 0至35 + 6周因早产症状就诊于急诊评估单元的女性数据进行分析。临床医生虽知晓定性胎儿纤连蛋白（fFN）结果，但对qfFN结果不知情。针对sPTB构建了具有时间更新协变量的参数生存模型，用于预测因素的组合，并使用赤池信息准则和贝叶斯信息准则选择最佳模型。该模型基于前190例连续女性构建，并在随后的192例中进行验证。计算每位患者在妊娠30、34或37周前以及检测后2或4周内分娩的估计概率，并与实际事件发生率进行比较。计算预测统计量以比较训练集和验证集。
最终选定的模型使用qfFN和既往sPTB/早产前胎膜早破（PPROM）作为预测因素。训练集和验证集的预测统计量相似，所有结局的预期sPTB与观察到的sPTB之间具有良好的一致性。受试者操作特征曲线下面积范围为0.77至0.88，表明对所有五种分娩结局均能进行准确预测。
使用结合qfFN和既往sPTB/PPROM的模型可准确预测有症状女性的sPTB。临床医生可使用该已纳入应用程序（QUiPP）的模型，准确确定女性的sPTB风险，并可能据此适当调整管理决策。
