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|Title:||Angiogenic factors combined with clinical risk factors to predict preterm pre-eclampsia in nulliparous women: a predictive test accuracy study|
|Citation:||BJOG, 2013; 120(10):1215-1223|
|Publisher:||Blackwell Publishing Ltd|
|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|
|Appears in Collections:||Obstetrics and Gynaecology publications|
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