Department of Internal Medicine, Division of Vascular Medicine and Pharmacology, Erasmus MC, Rotterdam, The Netherlands.
Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Rotterdam, The Netherlands.
Ultrasound Obstet Gynecol. 2021 Nov;58(5):698-704. doi: 10.1002/uog.23142. Epub 2021 Oct 6.
A model that can predict reliably the risk of pre-eclampsia (PE)-related pregnancy complications does not exist. The aim of this study was to develop and validate internally a clinical prediction model to predict the risk of a composite outcome of PE-related maternal and fetal complications within 7, 14 and 30 days of testing in women with suspected or confirmed PE.
The data for this study were derived from a prospective, multicenter, observational cohort study on women with a singleton pregnancy and suspected or confirmed PE at 20 to < 37 weeks' gestation. For the development of the prediction model, the possible contribution of clinical and standard laboratory variables, as well as the biomarkers soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF) and their ratio, in the prediction of a composite outcome of PE-related complications, consisting of maternal and fetal adverse events within 7, 14 and 30 days, was explored using multivariable competing-risks regression analysis. The discriminative ability of the model was assessed using the concordance (c-) statistic. A bootstrap validation procedure with 500 replications was used to correct the estimate of the prediction model performance for optimism and to compute a shrinkage factor for the regression coefficients to correct for overfitting.
Among 384 women with suspected or confirmed PE, 96 (25%) had an adverse PE-related outcome at any time after hospital admission. Important predictors of adverse PE-related outcome included sFlt-1/PlGF ratio, gestational age at the time of biomarker measurement and protein-to-creatinine ratio as continuous variables. The c-statistics (corrected for optimism) for developing a PE-related complication within 7, 14 and 30 days were 0.89, 0.88 and 0.87, respectively. There was limited overfitting, as indicated by a shrinkage factor of 0.91.
We propose a simple clinical prediction model with good discriminative performance to predict PE-related complications. Determination of its usefulness in clinical practice awaits further investigation and external validation. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
目前尚无可靠预测子痫前期（PE）相关妊娠并发症风险的模型。本研究旨在建立并验证一种内部临床预测模型，以预测疑似或确诊 PE 孕妇在检测后 7、14 和 30 天内发生与 PE 相关的母体和胎儿并发症的复合结局风险。
本研究数据来自一项前瞻性、多中心、观察性队列研究，纳入 20 至<37 孕周疑似或确诊 PE 的单胎妊娠女性。为了建立预测模型，使用多变量竞争风险回归分析探讨了临床和标准实验室变量以及生物标志物可溶性 fms 样酪氨酸激酶-1（sFlt-1）、胎盘生长因子（PlGF）及其比值在预测 7、14 和 30 天内与 PE 相关并发症（包括母体和胎儿不良事件）的复合结局中的可能作用。使用一致性（c）统计量评估模型的判别能力。采用 500 次重复的自举验证程序校正预测模型性能的估计值以纠正其对乐观偏差的影响，并计算回归系数的收缩因子以纠正过拟合。
在 384 例疑似或确诊 PE 女性中，96 例（25%）在住院后任何时间发生不良的与 PE 相关结局。不良与 PE 相关结局的重要预测因素包括 sFlt-1/PlGF 比值、生物标志物检测时的孕龄和蛋白尿-肌酐比值（连续变量）。发展 7、14 和 30 天内发生 PE 相关并发症的 c 统计量（经乐观偏差校正）分别为 0.89、0.88 和 0.87。收缩因子为 0.91，表明存在有限的过拟合。
我们提出了一种具有良好判别性能的简单临床预测模型，可用于预测与 PE 相关的并发症。其在临床实践中的应用价值有待进一步研究和外部验证。© 2020 约翰威立父子公司出版公司及其在世界各地的分支机构国际超声协会。
