Clinical Medicine Postgraduate Program, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Maternity School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Multidisciplinary Laboratory of Epidemiology and Health - LAMPES, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brasil.
Maternity School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Professional Master Program in Perinatal Health, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brasil.
Pregnancy Hypertens. 2021 Dec;26:110-115. doi: 10.1016/j.preghy.2021.10.005. Epub 2021 Oct 29.
To validate a combined algorithm for early prediction of pre-eclampsia (PE) in the Brazilian population.
This is an unplanned secondary analysis of a cohort study. Consecutive singleton pregnancies undergoing first-trimester screening for PE involving examination of maternal characteristics, medical history, and biophysical markers were considered eligible. Women were classified as low-or high-risk using a cutoff of 1/200, but the individual risk was not used to dictate management, as aspirin prophylaxis was given to women based solely on clinical risk factors. Receiver-operating characteristics (ROC) curves for PE, preterm PE(PE < 37) and early 34(PE < 34) were constructed and detection rates(DR) and false-positive rates(FPR) were calculated, adjusting for the effect of aspirin. Propensity score analysis was utilized to account for possible confounding by indication.
Screening performance and PE rates.
Among 1695 women, 323(19.1%) were classified as high-risk for PE and 1372(80.9%) were considered low-risk. Aspirin use was registered in 62(3.7%) in the high-risk group and 33(1.9%) in the low-risk group. There were 164(9.7%) women who developed PE, including 41(2.4%) with PE < 37 and 18(1.1%) PE < 34.Subgroups with aspirin had higher incidence of PE, suggest confounding by indication. The algorithm had an AUC of 0.87, DR of 72% for PE < 34; an AUC of 0.8, DR of 59% for PE < 37, both with FPR of 18%. Accounting for effect of aspirin, we observed an improvement in DR of PE < 37 to 67%.
Using combined predictive algorithm for preterm PE prediction is feasible in clinical practice in low/middle-income countries. Aspirin use needs to be accounted for when evaluating the performance of screening.
验证一种联合算法在巴西人群中对先兆子痫（PE）的早期预测。
这是一项队列研究的计划外二次分析。连续的单胎妊娠，进行 PE 的早孕期筛查，包括检查母体特征、病史和生物物理标志物，被认为符合条件。使用 1/200 的截断值将女性分为低风险或高风险，但个体风险并未用于指导管理，因为仅根据临床危险因素向女性给予阿司匹林预防。为了调整阿司匹林的影响，构建了 PE、早产 PE（PE<37）和早 34 周 PE（PE<34）的受试者工作特征（ROC）曲线，并计算了检出率（DR）和假阳性率（FPR）。利用倾向评分分析来考虑可能存在的指示性混杂因素。
筛查性能和 PE 发生率。
在 1695 名女性中，323 名（19.1%）被归类为 PE 高危，1372 名（80.9%）被归类为低危。高危组中有 62 名（3.7%）女性使用了阿司匹林，低危组中有 33 名（1.9%）女性使用了阿司匹林。共有 164 名（9.7%）女性发生 PE，其中 41 名（2.4%）为 PE<37 周，18 名（1.1%）为 PE<34 周。使用阿司匹林的亚组 PE 发生率较高，提示存在指示性混杂。该算法对 PE<34 的 AUC 为 0.87，DR 为 72%；对 PE<37 的 AUC 为 0.8，DR 为 59%，两者的 FPR 均为 18%。考虑到阿司匹林的影响，我们观察到 PE<37 的 DR 提高到 67%。
在中低收入国家的临床实践中，使用联合预测算法进行早产 PE 预测是可行的。在评估筛查的性能时，需要考虑阿司匹林的使用。
