Prognostic indicators of severe disease in women with late preterm
preeclampsia to guide decision making on timing of delivery: development
and validation of prognostic models
Abstract
Objective: to establish a prognostic model informing optimal timing of
delivery in women with late preterm preeclampsia. Design: development
and validation of a prognostic model Setting: prospective cohort study,
nested in the PHOENIX trial, in 36 maternity units across England and
Wales. Population: women with late preterm pre-eclampsia (34+0-36+6
weeks’ gestation) Methods: prospective recruitment of women in whom
blood samples for Placental Growth Factor (PlGF) and soluble fms-like
tyrosine kinase-1 (sFlt-1) testing was obtained, alongside clinical
data, for use within the ‘Prediction of complications in early-onset
pre-eclampsia’ (PREP)-S model. Candidate variables were compared using
standard methods (sensitivity, specificity, Receiver Operator Curve
areas). Estimated probability of early delivery from PREP-S was compared
to actual event rates by calibration. Main Outcome Measures: clinically
indicated need for delivery for pre-eclampsia within seven days.
Results: PlGF testing had high sensitivity (97.9%) for delivery within
seven days, but negative predictive value was only 71.4%, with low
specificity (8.4%). The area under the curve for PREP-S was 0.64
(standard error (SE) 0.03), for PlGF was 0.60 (SE 0.03), and 0.65
(0.03), and 0.64 (0.03) for PREP-S in combination with PlGF and
sFlt-1:PlGF, respectively. Conclusions: PlGF-based testing does not add
to clinical assessment to determine need for delivery in late preterm
pre-eclampsia. Existing models developed in women with early onset
pre-eclampsia to predict complications cannot be used to predict
clinically indicated need for delivery in women with late preterm
pre-eclampsia. Funding: NIHR HTA Monitoring Add on Studies Programme
(reference 15/59/06). Keywords: placental growth factor, preeclampsia,
prognosis