Dabi Yohann, Nedellec Sophie, Bonneau Claire, Trouchard Blandine, Rouzier Roman, Benachi Alexandra
Service de Gynécologie-Obstétrique, AP-HP, Hôpital Antoine Béclère, Université Paris Sud, Clamart, France.
Cellule de Transfert in Utero - Ile de France, Hôpital Antoine Béclère, Clamart, France.
PLoS One. 2017 Feb 9;12(2):e0171801. doi: 10.1371/journal.pone.0171801. eCollection 2017.
To validate a model predicting the risk of threatened preterm delivery and to establish the optimal threshold for this risk scoring system.
Two cohorts were studied: one of singleton pregnancies without preterm premature rupture of membranes (PPROM) and no cervical cerclage (cohort 1) and one of twin pregnancies without PPROM and no cervical cerclage (cohort 2). Patients were included from January 1st 2013 until December 31st 2013 by the Regional Perinatal Network of Ile de France with patients transferred because of threatened preterm delivery at 22 to 32 weeks of gestation. The individual probability of delivery within 48 hours of admission was calculated using the nomogram for every patient. Discrimination and calibration of the nomogram as well as the optimal threshold were determined using R studio.
The nomogram accurately predicted obstetric outcome. Discrimination and calibration were excellent, with an area under the curve (AUC) of 0.88 (95% CI 0.86-0.90) for cohort 1 and 0.73 (95% CI 0.66-0.80) for cohort 2. The optimal threshold would be 15% for cohort 1 and 10% for cohort 2. Using these thresholds, the performance characteristics of the nomogram were: sensitivity 80% (cohort 1) and 69% (cohort 2), negative predictive value 94.8% (cohort 1) and 91.3% (cohort 2). Use of the nomogram would avoid 253 unnecessary transfers in cohort 1.
The nomogram was efficient and clinically relevant in our high risk population. A threshold set at 15% would help minimize the risk of preterm deliveries in singleton pregnancies and should reduce unnecessary, costly and stressful in utero transfer.
验证一个预测先兆早产风险的模型，并确定该风险评分系统的最佳阈值。
研究了两个队列：一个是单胎妊娠队列，无胎膜早破（PPROM）且未行宫颈环扎术（队列1）；另一个是双胎妊娠队列，无PPROM且未行宫颈环扎术（队列2）。2013年1月1日至2013年12月31日期间，法国法兰西岛大区围产期网络纳入了因妊娠22至32周先兆早产而转诊的患者。使用列线图为每位患者计算入院后48小时内分娩的个体概率。使用R工作室确定列线图的辨别力、校准情况以及最佳阈值。
列线图准确预测了产科结局。辨别力和校准情况良好，队列1的曲线下面积（AUC）为0.88（95%CI 0.86 - 0.90），队列2的AUC为0.73（95%CI 0.66 - 0.80）。队列1的最佳阈值为15%，队列2的最佳阈值为10%。使用这些阈值时，列线图的性能特征为：敏感性80%（队列1）和69%（队列2），阴性预测值94.8%（队列1）和91.3%（队列2）。在队列1中使用列线图可避免253次不必要的转诊。
在我们的高危人群中，列线图有效且具有临床相关性。设定为15%的阈值有助于将单胎妊娠早产风险降至最低，并应减少不必要的、昂贵且有压力的宫内转诊。
