University of Liverpool and Liverpool Women's Hospital, Liverpool, UK.
Liverpool Health Partners, Liverpool, UK.
BJOG. 2019 Dec;126(13):1569-1575. doi: 10.1111/1471-0528.15886. Epub 2019 Aug 24.
The QUiPP algorithm combines cervical length, quantitative fetal fibronectin (qfFN) and medical history to quantify risk of preterm birth. We assessed the utility of QUiPP to inform preterm birth prevention treatment decisions.
A prospective cohort study with a subsequent impact assessment using the QUiPP risk of birth before 34 weeks' gestation.
A UK tertiary referral hospital.
In all, 119 women with previous spontaneous preterm birth (sPTB) or preterm premature rupture of membranes (PPROM) before 34 weeks' gestation.
Cervical length and qfFN were measured at 19 to 23 weeks' gestation. Clinical management was based on history and cervical length. After birth, clinicians were unblinded to qfFN results and QUiPP analysis was undertaken.
Predictive statistics of QUiPP algorithm using 10% risk of sPTB before 34 weeks as treatment threshold.
Fifteen of 119 women (13%) had PPROM or sPTB before 34 weeks. Of these, 53% (8/15) had QUiPP risk of sPTB before 34 weeks above 10%. Applying this treatment threshold in practice would have doubled our treatment rate (20 versus 42%). QUIPP threshold of 10% had positive likelihood ratio (LR) of 1.3 (95% CI 0.76-2.18), and negative LR of 0.8 (95% CI 0.45-1.40) for predicting sPTB before 34 weeks.
Use of the QUiPP algorithm in this population may lead to substantial increase in interventions without evidence that currently available treatment options are beneficial for this particular group.
Independent study finds that the QUiPP algorithm could lead to substantial increases in treatment without evidence of benefit.
QUIPP 算法结合了宫颈长度、定量胎儿纤维连接蛋白（qfFN）和病史，以量化早产风险。我们评估了 QUiPP 在告知早产预防治疗决策方面的效用。
一项前瞻性队列研究，随后使用 QUiPP 预测 34 周前分娩的风险进行影响评估。
英国的一家三级转诊医院。
共有 119 名有既往自发性早产（sPTB）或 34 周前胎膜早破（PPROM）病史的女性。
在 19 至 23 周时测量宫颈长度和 qfFN。临床管理基于病史和宫颈长度。分娩后，医生们对 qfFN 结果和 QUiPP 分析进行了盲法处理。
以 10%的 sPTB 风险作为治疗阈值，使用 QUiPP 算法的预测统计数据。
119 名女性中有 15 名（13%）在 34 周前发生了 PPROM 或 sPTB。其中，53%（8/15）的 QUiPP 预测 34 周前 sPTB 的风险高于 10%。在实践中应用这一治疗阈值可能会使我们的治疗率翻倍（20%对 42%）。QUiPP 阈值为 10%时，预测 34 周前 sPTB 的阳性似然比（LR）为 1.3（95%CI 0.76-2.18），阴性似然比为 0.8（95%CI 0.45-1.40）。
在该人群中使用 QUiPP 算法可能会导致干预措施的大量增加，但目前尚无证据表明这些治疗选择对这一特定人群有益。
独立研究发现，QUIPP 算法可能会导致治疗的大幅增加，但没有证据表明其有益。
