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Multicenter Study
. 2022 Jan;59(1):69-75.
doi: 10.1002/uog.24789.

STATIN trial: predictive performance of competing-risks model in screening for pre-eclampsia at 35-37 weeks' gestation

M Döbert  1 , A Wright  2 , A N Varouxaki  1 , A C Mu  1 , A Syngelaki  1 , A Rehal  1 , J L Delgado  3 , R Akolekar  4 , G Muscettola  5 , D Janga  6 , M Singh  7 , R Martin-Alonso  8 , V Dütemeyer  9 , M De Alvarado  10 , V Atanasova  11 , D Wright  2 , K H Nicolaides  1
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Free article
Multicenter Study

STATIN trial: predictive performance of competing-risks model in screening for pre-eclampsia at 35-37 weeks' gestation

M Döbert et al. Ultrasound Obstet Gynecol. 2022 Jan.
Free article

Abstract

Objective: To examine the predictive performance of a previously reported competing-risks model of screening for pre-eclampsia (PE) at 35-37 weeks' gestation by combinations of maternal risk factors, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), serum placental growth factor (PlGF) and serum soluble fms-like tyrosine kinase-1 (sFlt-1) in a validation dataset derived from the screened population of the STATIN study.

Methods: This was a prospective third-trimester multicenter study of screening for PE in singleton pregnancies by means of a previously reported algorithm that combines maternal risk factors and biomarkers. Women in the high-risk group were invited to participate in a trial of pravastatin vs placebo, but the trial showed no evidence of an effect of pravastatin in the prevention of PE. Patient-specific risks of delivery with PE were calculated using the competing-risks model, and the performance of screening for PE by maternal risk factors alone and by various combinations of risk factors with MAP, UtA-PI, PlGF and sFlt-1 was assessed. The predictive performance of the model was examined by, first, the ability of the model to discriminate between the PE and no-PE groups using the area under the receiver-operating-characteristics curve (AUC) and the detection rate at a fixed false-positive rate of 10%, and, second, calibration by measurements of calibration slope and calibration-in-the-large.

Results: The study population of 29 677 pregnancies contained 653 that developed PE. In screening for PE by a combination of maternal risk factors, MAP, PlGF and sFlt-1 (triple test), the detection rate at a 10% false-positive rate was 79% (95% CI, 76-82%) and the results were consistent with the data used for developing the algorithm. Addition of UtA-PI did not improve the prediction provided by the triple test. The AUC for the triple test was 0.923 (95% CI, 0.913-0.932), demonstrating very high discrimination between affected and unaffected pregnancies. Similarly, the calibration slope was 0.875 (95% CI, 0.831-0.919), demonstrating good agreement between the predicted risk and observed incidence of PE.

Conclusion: The competing-risks model provides an effective and reproducible method for third-trimester prediction of term PE. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Keywords: calibration; competing-risks model; discrimination; mean arterial blood pressure; performance of screening; placental growth factor; pre-eclampsia; soluble fms-like tyrosine kinase-1; survival model; third-trimester screening; uterine artery Doppler.

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References

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