fullPIERS预测模型在398例子痫前期人群中的外部确认
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摘要
目的:采用fullPIERS模型,对其预测子痫前期(PE)患者发生不良妊娠结局的能力进行单中心的初步外部确认。方法:回顾性研究2014年1月—2015年12月苏州市立医院收治的PE孕妇共398例,采用fullPIERS模型预测其入院48 h内和2～7 d内发生不良妊娠结局的可能性,初步评估fullPIERS模型的预测能力。通过预测模型绘制受试者工作特征(ROC)曲线,计算ROC曲线下面积(AUC)评估模型的区分度,采用H-L拟合优度检验评估模型的校准度,采用分层表格评估模型的分层能力,最终对fullPIERS模型进行概括性的外部确认。结果:在398例PE孕妇中,不良妊娠结局的发生率为16.8%(67/398),其中入院48 h内不良妊娠结局发生率为10.3%(41/398),入院2～7 d内不良妊娠结局发生率为5.3%(21/398)。full PIERS模型预测PE孕妇入院48 h内发生不良妊娠结局的AUC为0.855(95%CI:0.782～0.928,P<0.001),预测入院2～7 d内发生不良妊娠结局的AUC为0.826 (95%CI:0.727～0.925,P <0.001)。fullPIERS模型对PE孕妇入院48 h内和2～7 d内发生不良妊娠结局阴性预测值分别为96.9%(286/295)和98.7%(312/316),阳性预测值分别为31.1%(32/103)和20.7%(17/82)。fullPIERS模型预测PE孕妇入院48 h内发生不良妊娠结局时校准度较好(χ~2=6.431,P=0.599);预测入院2～7 d内发生不良妊娠结局时校准度较差(χ~2=36.778,P=0.000)。结论:在单中心PE人群中,full PIERS模型对入院48 h内发生不良妊娠结局具有较好的预测能力,同时具有良好的分层能力和校准度,可以将full PIERS模型作为PE人群发生不良妊娠结局的一种常规评估手段。
Objective:To validate the prediction value of adverse pregnancy outcomes of fullPIERS model in women with pre-eclampsia(PE). Methods: This was a retrospective study. 398 pregnant women with PE hospitalized in Suzhou Municipal Hospital from January 2014 to December 2015 were included to analyze. The fullPIERS was applied to predict the adverse pregnancy outcomes within 48 h and 2-7 days after hospitalization. The discrimination(ROC AUC), risk stratification and calibration(H-L test and calibration plot) of the model were assessed. The comprehensive external validation of fullPIERS model was accomplished. Results: Among 398 pregnant women with PE, 67(16.8%) of whom had adverse outcomes, including 41(10.3%) within 48 h and 21(5.3%) within 2-7 days. The area under the curve of fullPIERS model to predict adverse outcomes was 0.855 within 48 h,and 0.826 with in 2-7 days after hospitalization. The negative prediction value(NPV) of model to predict adverse outcomes within 48 h and 2-7 days were 96.9%(286/295) and 98.7%(312/316), while the positive prediction value(PPV) were 31.1%(32/103) and 20.7%(17/82). The calibration of fullPIERS model was good( χ~2=6.431, P=0.599) within 48 h,but was poor( χ~2=36.778, P=0.000) within 2-7 days. Conclusions: The fullPIERS model performed well to predict the adverse pregnancy outcomes in women with PE in single center of east China, especially within 48 h after hospitalization. The model might be used as a routine test to predict the adverse pregnancy outcomes in women with PE.
Objective:To validate the prediction value of adverse pregnancy outcomes of fullPIERS model in women with pre-eclampsia(PE). Methods: This was a retrospective study. 398 pregnant women with PE hospitalized in Suzhou Municipal Hospital from January 2014 to December 2015 were included to analyze. The fullPIERS was applied to predict the adverse pregnancy outcomes within 48 h and 2-7 days after hospitalization. The discrimination(ROC AUC), risk stratification and calibration(H-L test and calibration plot) of the model were assessed. The comprehensive external validation of fullPIERS model was accomplished. Results: Among 398 pregnant women with PE, 67(16.8%) of whom had adverse outcomes, including 41(10.3%) within 48 h and 21(5.3%) within 2-7 days. The area under the curve of fullPIERS model to predict adverse outcomes was 0.855 within 48 h,and 0.826 with in 2-7 days after hospitalization. The negative prediction value(NPV) of model to predict adverse outcomes within 48 h and 2-7 days were 96.9%(286/295) and 98.7%(312/316), while the positive prediction value(PPV) were 31.1%(32/103) and 20.7%(17/82). The calibration of fullPIERS model was good( χ~2=6.431, P=0.599) within 48 h,but was poor( χ~2=36.778, P=0.000) within 2-7 days. Conclusions: The fullPIERS model performed well to predict the adverse pregnancy outcomes in women with PE in single center of east China, especially within 48 h after hospitalization. The model might be used as a routine test to predict the adverse pregnancy outcomes in women with PE.
引文
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[10]Tajik P,Oude Rengerink K,Ganzevoort W,et al.Prediction of preeclampsia complications[J].Lancet,2011,377(9774):1313.
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[12]Akkermans J,Payne B,von Dadelszen P,et al.Predicting complications in pre-eclampsia:external validation of the fullPIERSmodel using the PETRA trial dataset[J].Eur J Obstet Gynecol Reprod Biol,2014,179:58-62.
[13]Almeida ST,Katz L,Coutinho I,et al.Validation of fullPIERS model for prediction of adverse outcomes among women with severe preeclampsia[J].Int J Gynaecol Obstet,2017,138(2):142-147.
[14]沈敏红,韩冰.fullPIERS预测模型用于574例妊娠高血压人群的初探[J].现代妇产科进展,2012,21(3):172-174.
[15]Payne BA,Hutcheon JA,Ansermino JM,et al.A risk prediction model for the assessment and triage of women with hypertensive disorders of pregnancy in low-resourced settings:the miniPIERS(Pre-eclampsia Integrated Estimate of RiSk)multi-country prospective cohort study[J].PLoS Med,2014,11(1):e1001589.
[16]Nakimuli A,Mbalinda SN,Nabirye RC,et al.Still births,neonata deaths and neonatal near miss cases attributable to severe obstetric complications:a prospective cohort study in two referral hospitals in Uganda[J].BMC Pediatr,2015,15:44.
[17]Agrawal S,Maitra N.Prediction of Adverse Maternal Outcomes in Preeclampsia Using a Risk Prediction Model[J].J Obstet Gynaecol India,2016,66(Suppl 1):104-111.
[2]曹泽毅,乔杰.妇产科学[M].2版.北京:人民卫生出版社,2014:138-150.
[3]Horton R.What will it take to stop maternal deaths?[J].Lancet,2009,374(9699):1400-1402.
[4]Nankali A,Malek-KhosraviSh,Zangeneh M,et al.Maternal complications associated with severe preeclampsia[J].J Obstet Gynaecol India,2013,63(2):112-115.
[5]Seyom E,Abera M,TesfayeM,et al.Maternal and fetal outcome of pregnancy related hypertension in Mettu Karl Referral Hospital,Ethiopia[J].J Ovarian Res,2015,8:10.
[6]Wynn A,Cabeza J,Adachi K,et al.Frequency of maternal and newborn birth outcomes,Lima,Peru,2013[J].PLoS One,2015,10(3):e0116102.
[7]Abalos E,Cuesta C,Carroli G,et al.Pre-eclampsia,eclampsia and adverse maternal and perinatal outcomes:a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health[J].BJOG,2014,121(Suppl 1):14-24.
[8]Steegers EA,von Dadelszen P,Duvekot JJ,et al.Pre-eclampsia[J].Lancet,2010,376(9741):631-644.
[9]von Dadelszen P,Payne B,Li J,et al.Prediction of adverse maternal outcomes in pre-eclampsia:development and validation of the fullPIERSmodel[J].Lancet,2011,377(9761):219-227.
[10]Tajik P,Oude Rengerink K,Ganzevoort W,et al.Prediction of preeclampsia complications[J].Lancet,2011,377(9774):1313.
[11]Leushuis E,van der Steeg JW,Steures P,et al.Prediction models in reproductive medicine:a critical appraisal[J].Hum Reprod Update,2009,15(5):537-552.
[12]Akkermans J,Payne B,von Dadelszen P,et al.Predicting complications in pre-eclampsia:external validation of the fullPIERSmodel using the PETRA trial dataset[J].Eur J Obstet Gynecol Reprod Biol,2014,179:58-62.
[13]Almeida ST,Katz L,Coutinho I,et al.Validation of fullPIERS model for prediction of adverse outcomes among women with severe preeclampsia[J].Int J Gynaecol Obstet,2017,138(2):142-147.
[14]沈敏红,韩冰.fullPIERS预测模型用于574例妊娠高血压人群的初探[J].现代妇产科进展,2012,21(3):172-174.
[15]Payne BA,Hutcheon JA,Ansermino JM,et al.A risk prediction model for the assessment and triage of women with hypertensive disorders of pregnancy in low-resourced settings:the miniPIERS(Pre-eclampsia Integrated Estimate of RiSk)multi-country prospective cohort study[J].PLoS Med,2014,11(1):e1001589.
[16]Nakimuli A,Mbalinda SN,Nabirye RC,et al.Still births,neonata deaths and neonatal near miss cases attributable to severe obstetric complications:a prospective cohort study in two referral hospitals in Uganda[J].BMC Pediatr,2015,15:44.
[17]Agrawal S,Maitra N.Prediction of Adverse Maternal Outcomes in Preeclampsia Using a Risk Prediction Model[J].J Obstet Gynaecol India,2016,66(Suppl 1):104-111.