External validation of a simple risk score based on the ASPRE trial algorithm for preterm pre-eclampsia considering maternal characteristics in nulliparous pregnant women: a multicentre retrospective cohort study: BJOG: An International Journal of Obstetrics and Gynaecology

E. Brunelli, A. Seidenari, C. Germano, F. Prefumo, P. Cavoretto, D. Di Martino, B. Masturzo, D. Morano, N. Rizzo, A. Farina

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To validate the performance of a first-trimester simple risk score based on the ASPRE trial algorithm for pre-eclampsia. Design: Multicentre retrospective cohort analysis. Setting: Four Italian hospitals. Population: Unselected nulliparous women at 11–13 weeks of gestation from January 2014 through to January 2018. Methods: Model performance was evaluated based on discrimination and calibration. Main outcome measures: Delivery before 37 weeks of gestation with a diagnosis of pre-eclampsia. Results: Based on 73 preterm pre-eclampsia cases and 7546 controls (including 101 cases of late pre-eclampsia), the area under the receiver operating characteristics curve was 0.659 (95% CI 0.579–0.726). The sensitivity was 32.9% (95% CI 22.1–43.7) at a false-positive rate of 8.8%. The positive likelihood ratio was 3.74 (95% CI 2.67–5.23), the positive predictive value was 3.49% (95% CI 2.12–4.86%) and the negative predictive value was 99.3% (95% CI 99.1–99.5%). The sensitivity and positive likelihood ratio were approximately 40% lower than in the original study. The calibration analysis showed a good agreement between observed and expected risks (P = 0.037). Comparison with the Fetal Medicine Foundation (FMF) algorithm yielded a difference in the area under the curve of 0.084 (P = 0.007). Conclusions: In our Italian population, the simple risk score had a lower performance than expected for the prediction of preterm pre-eclampsia in nulliparous women. The FMF algorithm applied to the same data set resulted in a better prediction. Tweetable abstract: Simple risk score predicts preterm pre-eclampsia in Italy. © 2020 Royal College of Obstetricians and Gynaecologists
Original languageEnglish
Pages (from-to)1210-1215
Number of pages6
JournalBJOG Int. J. Obstet. Gynaecol.
Volume127
Issue number10
DOIs
Publication statusPublished - 2020

Keywords

  • algorithm
  • aspirin
  • first-trimester
  • multivariable analysis
  • pre-eclampsia
  • prediction
  • screening
  • Article
  • ASPRE trial algorithm
  • cohort analysis
  • controlled study
  • female
  • first trimester pregnancy
  • gestational age
  • human
  • instrument validation
  • intermethod comparison
  • major clinical study
  • nullipara
  • predictive value
  • preeclampsia
  • pregnant woman
  • priority journal
  • retrospective study
  • risk algorithm
  • sample size
  • scoring system
  • sensitivity analysis
  • adult
  • case control study
  • clinical trial
  • early diagnosis
  • Italy
  • multicenter study
  • pregnancy
  • risk assessment
  • Adult
  • Algorithms
  • Case-Control Studies
  • Early Diagnosis
  • Female
  • Humans
  • Pre-Eclampsia
  • Predictive Value of Tests
  • Pregnancy
  • Pregnancy Trimester, First
  • Retrospective Studies
  • Risk Assessment

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