Comparison of the discriminatory accuracy of four risk criteria for preeclampsia.

OBJECTIVES

Several criteria have been proposed to categorize the risk of preeclampsia, with notable differences between these criteria. We compared the discriminatory accuracy of criteria for categorizing preeclampsia risk established by four institutions, namely, the World Health Organization (WHO), National Institute for Health and Care Excellence (NICE), American College of Obstetricians and Gynecologists (ACOG), and National Center for Technological Excellence in Health (CENETEC), and estimated the concordance between these criteria.

STUDY DESIGN

We performed a secondary data analysis of 590 Mexican obstetric patients who received prenatal care in primary care between 2016 and 2017; 160 had a diagnosis of preeclampsia.

MAIN OUTCOME MEASURES

We estimated the true (TP) and false positive (FP) fractions, positive (PPV) and negative predictive values (NPV), positive (LR+) and negative (LR-) likelihood ratios, diagnostic odds ratio (DOR), area under the receiver operating characteristic curve (AUROC), and Kappa coefficient with corresponding 95% confidence intervals (CIs).

RESULTS

Only the WHO criteria, followed by the NICE criteria, had the greatest number of accuracy indicators with ideal or acceptable results: TP 83.6%, PPV 60.5%, NPV 90.3%, DOR 14.3, and AUROC 0.79 and TP 84.5%, PPV 51.0%, NPV 90.3%, DOR 9.7, and AUROC 0.74, respectively. The Kappa coefficient between WHO and NICE criteria was 0.78 (95% CI 0.71-0.85).

CONCLUSIONS

The discriminatory accuracies of the WHO and NICE criteria were superior to those of the ACOG and CENETEC criteria for classifying preeclampsia risk. Their concordance was good; thus, both criteria seem appropriate for screening preeclampsia in primary care.