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https://hdl.handle.net/2440/78865
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Type: | Journal article |
Title: | Angiogenic factors combined with clinical risk factors to predict preterm pre-eclampsia in nulliparous women: a predictive test accuracy study |
Author: | Myers, J. Kenny, L. McCowan, L. Chan, E. Dekker, G. Poston, L. Simpson, N. North, R. |
Citation: | BJOG: an International Journal of Obstetrics and Gynaecology, 2013; 120(10):1215-1223 |
Publisher: | Blackwell Publishing Ltd |
Issue Date: | 2013 |
ISSN: | 1470-0328 1471-0528 |
Statement of Responsibility: | J.E. Myers, L.C. Kenny, L.M.E. McCowan, E.H.Y. Chan, G.A. Dekker, L. Poston, N.A.B. Simpson, R.A. North, on behalf of the SCOPE Consortium |
Abstract: | OBJECTIVES: To assess the performance of clinical risk factors, uterine artery Doppler and angiogenic markers to predict preterm pre-eclampsia in nulliparous women. DESIGN: Predictive test accuracy study. SETTING: Prospective multicentre cohort study Screening for Pregnancy Endpoints (SCOPE). METHODS: Low-risk nulliparous women with a singleton pregnancy were recruited. Clinical risk factor data were obtained and plasma placental growth factor (PlGF), soluble endoglin and soluble fms-like tyrosine kinase-1 (sFlt-1) were measured at 14–16 weeks of gestation. Prediction models were developed using multivariable stepwise logistic regression. MAIN outcome measure Preterm pre-eclampsia (delivered before 37+0 weeks of gestation). RESULTS Of the 3529 women recruited, 187 (5.3%) developed pre-eclampsia of whom 47 (1.3%) delivered preterm. Controls (n = 188) were randomly selected from women without preterm pre-eclampsia and included women who developed other pregnancy complications. An area under a receiver operating characteristic curve (AUC) of 0.76 (95% CI 0.67–0.84) was observed using previously reported clinical risk variables. The AUC improved following the addition of PlGF measured at 14–16 weeks (0.84; 95% CI 0.77–0.91), but no further improvement was observed with the addition of uterine artery Doppler or the other angiogenic markers. A sensitivity of 45% (95% CI 0.31–0.59) (5% false-positive rate) and post-test probability of 11% (95% CI 9–13) were observed using clinical risk variables and PlGF measurement. CONCLUSIONS: Addition of plasma PlGF at 14–16 weeks of gestation to clinical risk assessment improved the identification of nulliparous women at increased risk of developing preterm pre-eclampsia, but the performance is not sufficient to warrant introduction as a clinical screening test. These findings are marker dependent, not assay dependent; additional markers are needed to achieve clinical utility. |
Keywords: | Angiogenic markers placental growth factor pre-eclampsia sensitivity specificity |
Rights: | © 2013 The Authors |
DOI: | 10.1111/1471-0528.12195 |
Published version: | http://dx.doi.org/10.1111/1471-0528.12195 |
Appears in Collections: | Aurora harvest Obstetrics and Gynaecology publications |
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