Department of Anaesthesia and Intensive Care, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Bron, France.
University of Lyon, Claude Bernard Lyon 1 University, Villeurbanne, France.
BJOG. 2021 Nov;128(12):1966-1973. doi: 10.1111/1471-0528.16672. Epub 2021 Mar 17.
OBJECTIVE: To assess the contribution of maternal blood detection of IGFBP-1 for the diagnosis of amniotic-fluid embolism in clinical daily practice. DESIGN: A retrospective multicentre cohort study. SETTING: Three tertiary care obstetric units in France. SAMPLE: Data of 86 women for whom amniotic-fluid embolism had been suspected and maternal serum detection of IGFBP-1 had been performed between 2011 and 2019 were analysed. METHODS: The criteria defined by the United Kingdom Obstetric Surveillance System (UKOSS) were used for the retrospective diagnosis of amniotic-fluid embolism. The more structured definition proposed by the Society for Maternal-Fetal Medicine and the Amniotic Fluid Embolism Foundation (SMFM) was also used as secondary endpoint. MAIN OUTCOME MEASURES: Agreements between biological and clinical assessments were tested. The performance of blood detection of IGFBP-1 for the diagnosis of amniotic-fluid embolism according to the UKOSS criteria, and to the SMFM definition, was also assessed. RESULTS: There was only slight agreement between clinical and laboratory diagnosis of amniotic-fluid embolism (Cohen's Kappa coefficient: 0.04). Blood detection of IGFBP-1 had a sensitivity of 16%, a specificity of 88%, a positive and a negative likelihood ratio of 1.3 and 0.95, respectively, and a positive and a negative predictive value of 58 and 50%, respectively, for the diagnosis of amniotic-fluid embolism based on the UKOSS criteria. The use of the more structured SMFM definition of amniotic-fluid embolism did not substantially change the results. CONCLUSION: These results question the usefulness of blood detection of IGFBP-1 for the early diagnosis of amniotic-fluid embolism in daily clinical practice. TWEETABLE ABSTRACT: This retrospective multicentre study questions the contribution of IGFBP-1 detection for the diagnosis of AFE.
目的：评估母体血液 IGFBP-1 检测在临床日常实践中对羊水栓塞诊断的贡献。
设计：回顾性多中心队列研究。
地点：法国三个三级保健产科单位。
样本：分析了 2011 年至 2019 年间怀疑羊水栓塞且进行了母体血清 IGFBP-1 检测的 86 名妇女的数据。
方法：使用英国产科监测系统 (UKOSS) 定义的标准进行羊水栓塞的回顾性诊断。还使用母体胎儿医学学会和羊水栓塞基金会 (SMFM) 提出的更具结构性的定义作为次要终点。
主要观察指标：测试生物和临床评估之间的一致性。还评估了根据 UKOSS 标准和 SMFM 定义进行 IGFBP-1 血液检测对羊水栓塞诊断的性能。
结果：临床和实验室诊断羊水栓塞之间只有轻微的一致性（Cohen's Kappa 系数：0.04）。根据 UKOSS 标准，IGFBP-1 血液检测的灵敏度为 16%，特异性为 88%，阳性和阴性似然比分别为 1.3 和 0.95，阳性和阴性预测值分别为 58%和 50%，用于诊断羊水栓塞。使用羊水栓塞的更具结构性的 SMFM 定义并没有实质性地改变结果。
结论：这些结果对 IGFBP-1 血液检测在日常临床实践中对羊水栓塞的早期诊断的有用性提出了质疑。
J Gynecol Obstet Hum Reprod. 2020-11
Anesth Analg. 2018-1
Ann Biol Clin (Paris). 2007
J Gynecol Obstet Hum Reprod. 2023-6
Ann Fr Anesth Reanim. 2013-3
Am J Obstet Gynecol. 2016-10
Autops Case Rep. 2021-8-20
Zotero 插件