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Revisiting the discriminatory accuracy of traditional risk factors in preeclampsia screening

Rodriguez-Lopez, Merida LU ; Wagner, Philippe LU ; Perez Vicente, Raquel LU orcid ; Crispi, Fatima and Merlo, Juan LU orcid (2017) In PLoS ONE 12(5).
Abstract

BACKGROUND: Preeclampsia (PE) is associated with a high risk of perinatal morbidity and mortality. However, there is no consensus in the definition of high-risk women.

AIM: To question current definition of high PE risk and propose a definition that considers individual heterogeneity to improves risk classification.

METHODS: A stratified analysis by parity was conducted using the Swedish Birth Register between 2002-2010 including 626.600 pregnancies. The discriminatory accuracy (DA) of traditional definitions of high-risk women was compared with a new definition based on 1) specific combinations of individual variables and 2) a centile cut-off of the probability of PE predicted by a multiple logistic regression... (More)

BACKGROUND: Preeclampsia (PE) is associated with a high risk of perinatal morbidity and mortality. However, there is no consensus in the definition of high-risk women.

AIM: To question current definition of high PE risk and propose a definition that considers individual heterogeneity to improves risk classification.

METHODS: A stratified analysis by parity was conducted using the Swedish Birth Register between 2002-2010 including 626.600 pregnancies. The discriminatory accuracy (DA) of traditional definitions of high-risk women was compared with a new definition based on 1) specific combinations of individual variables and 2) a centile cut-off of the probability of PE predicted by a multiple logistic regression model.

RESULTS: None of the classical risk-factors alone reached an acceptable DA. In multiparous, any combination of a risk-factor with previous PE or HBP reached a +LR>10. The combination of obesity and multiple pregnancy reached a good DA particularly in the presence of previous preeclampsia (positive likelihood ratio (LR+) = 26.5 or chronic hypertension (HBP) LR+ = 40.5. In primiparous, a LR+>15 was observed in multiple pregnancies with the simultaneous presence of obesity and diabetes mellitus or with HBP. Predicted probabilities above 97 centile in multiparous and 99 centile in primiparous provided high (LR+ = 12.5), and moderate (LR+ = 5.85), respectively. No one risk factor alone or in combination provided a LR- sufficiently low to rule-out the disease.

CONCLUSIONS: In preeclampsia prediction the combination of specific risk factors provided a better discriminatory accuracy than traditional single risk approach. Our results contribute to a more personalized risk estimation of preeclampsia.

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Please use this url to cite or link to this publication:
author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
PLoS ONE
volume
12
issue
5
article number
e0178528
publisher
Public Library of Science (PLoS)
external identifiers
  • pmid:28542517
  • scopus:85019693368
  • wos:000402062800101
ISSN
1932-6203
DOI
10.1371/journal.pone.0178528
project
Multilevel analysis of individual heterogeneity
language
English
LU publication?
yes
id
8b8663ab-91f9-4231-8858-5a2a531687b9
date added to LUP
2017-05-31 07:12:59
date last changed
2025-04-04 13:59:46
@article{8b8663ab-91f9-4231-8858-5a2a531687b9,
  abstract     = {{<p>BACKGROUND: Preeclampsia (PE) is associated with a high risk of perinatal morbidity and mortality. However, there is no consensus in the definition of high-risk women.</p><p>AIM: To question current definition of high PE risk and propose a definition that considers individual heterogeneity to improves risk classification.</p><p>METHODS: A stratified analysis by parity was conducted using the Swedish Birth Register between 2002-2010 including 626.600 pregnancies. The discriminatory accuracy (DA) of traditional definitions of high-risk women was compared with a new definition based on 1) specific combinations of individual variables and 2) a centile cut-off of the probability of PE predicted by a multiple logistic regression model.</p><p>RESULTS: None of the classical risk-factors alone reached an acceptable DA. In multiparous, any combination of a risk-factor with previous PE or HBP reached a +LR&gt;10. The combination of obesity and multiple pregnancy reached a good DA particularly in the presence of previous preeclampsia (positive likelihood ratio (LR+) = 26.5 or chronic hypertension (HBP) LR+ = 40.5. In primiparous, a LR+&gt;15 was observed in multiple pregnancies with the simultaneous presence of obesity and diabetes mellitus or with HBP. Predicted probabilities above 97 centile in multiparous and 99 centile in primiparous provided high (LR+ = 12.5), and moderate (LR+ = 5.85), respectively. No one risk factor alone or in combination provided a LR- sufficiently low to rule-out the disease.</p><p>CONCLUSIONS: In preeclampsia prediction the combination of specific risk factors provided a better discriminatory accuracy than traditional single risk approach. Our results contribute to a more personalized risk estimation of preeclampsia.</p>}},
  author       = {{Rodriguez-Lopez, Merida and Wagner, Philippe and Perez Vicente, Raquel and Crispi, Fatima and Merlo, Juan}},
  issn         = {{1932-6203}},
  language     = {{eng}},
  number       = {{5}},
  publisher    = {{Public Library of Science (PLoS)}},
  series       = {{PLoS ONE}},
  title        = {{Revisiting the discriminatory accuracy of traditional risk factors in preeclampsia screening}},
  url          = {{http://dx.doi.org/10.1371/journal.pone.0178528}},
  doi          = {{10.1371/journal.pone.0178528}},
  volume       = {{12}},
  year         = {{2017}},
}