Fetal Medicine Research Institute, King's College Hospital, London, UK.
University of Exeter, Exeter, UK.
Ultrasound Obstet Gynecol. 2022 Jan;59(1):69-75. doi: 10.1002/uog.24789.
To examine the predictive performance of a previously reported competing-risks model of screening for pre-eclampsia (PE) at 35-37 weeks' gestation by combinations of maternal risk factors, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), serum placental growth factor (PlGF) and serum soluble fms-like tyrosine kinase-1 (sFlt-1) in a validation dataset derived from the screened population of the STATIN study.
This was a prospective third-trimester multicenter study of screening for PE in singleton pregnancies by means of a previously reported algorithm that combines maternal risk factors and biomarkers. Women in the high-risk group were invited to participate in a trial of pravastatin vs placebo, but the trial showed no evidence of an effect of pravastatin in the prevention of PE. Patient-specific risks of delivery with PE were calculated using the competing-risks model, and the performance of screening for PE by maternal risk factors alone and by various combinations of risk factors with MAP, UtA-PI, PlGF and sFlt-1 was assessed. The predictive performance of the model was examined by, first, the ability of the model to discriminate between the PE and no-PE groups using the area under the receiver-operating-characteristics curve (AUC) and the detection rate at a fixed false-positive rate of 10%, and, second, calibration by measurements of calibration slope and calibration-in-the-large.
The study population of 29 677 pregnancies contained 653 that developed PE. In screening for PE by a combination of maternal risk factors, MAP, PlGF and sFlt-1 (triple test), the detection rate at a 10% false-positive rate was 79% (95% CI, 76-82%) and the results were consistent with the data used for developing the algorithm. Addition of UtA-PI did not improve the prediction provided by the triple test. The AUC for the triple test was 0.923 (95% CI, 0.913-0.932), demonstrating very high discrimination between affected and unaffected pregnancies. Similarly, the calibration slope was 0.875 (95% CI, 0.831-0.919), demonstrating good agreement between the predicted risk and observed incidence of PE.
The competing-risks model provides an effective and reproducible method for third-trimester prediction of term PE. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
通过结合母体危险因素、平均动脉压（MAP）、子宫动脉搏动指数（UtA-PI）、血清胎盘生长因子（PlGF）和血清可溶性 fms 样酪氨酸激酶-1（sFlt-1），在 STATIN 研究的筛查人群中验证来自已发表的竞争风险模型预测 35-37 周妊娠子痫前期（PE）的表现。
这是一项针对单胎妊娠的 PE 筛查的前瞻性三期末多中心研究，使用了之前报道的一种结合了母体危险因素和生物标志物的算法。高危组的妇女被邀请参加普伐他汀与安慰剂的试验，但该试验未发现普伐他汀在预防 PE 方面的作用。使用竞争风险模型计算患者发生 PE 的具体风险，并评估仅使用母体危险因素以及使用 MAP、UtA-PI、PlGF 和 sFlt-1 的各种危险因素组合筛查 PE 的性能。首先通过接受者操作特征曲线（AUC）下的区域来评估模型区分 PE 组和非 PE 组的能力，以及在固定假阳性率为 10%时的检出率，其次通过校准斜率和大样本校准来评估模型的校准。
研究人群中 29677 例妊娠中 653 例发生 PE。在使用母体危险因素、MAP、PlGF 和 sFlt-1 的组合（三联试验）筛查 PE 时，假阳性率为 10%时的检出率为 79%（95%CI，76-82%），结果与用于开发算法的数据一致。添加 UtA-PI 并不能提高三联试验的预测效果。三联试验的 AUC 为 0.923（95%CI，0.913-0.932），表明在受影响和未受影响的妊娠之间有非常高的区分度。同样，校准斜率为 0.875（95%CI，0.831-0.919），表明预测风险与实际发生 PE 的情况吻合较好。
竞争风险模型为三期末预测足月 PE 提供了一种有效且可重复的方法。© 2021 年国际妇产科超声学会。
