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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
Author(s) -
Brunelli E,
Seidenari A,
Germano C,
Prefumo F,
Cavoretto P,
Di Martino D,
Masturzo B,
Morano D,
Rizzo N,
Farina A
Publication year - 2020
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.16246
Subject(s) - medicine , eclampsia , obstetrics , receiver operating characteristic , likelihood ratios in diagnostic testing , retrospective cohort study , gestation , population , cohort , pregnancy , cohort study , area under the curve , gynecology , algorithm , mathematics , genetics , environmental health , biology
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.