Ophthalmic artery Doppler for pre-eclampsia prediction at the first trimester: a Bayesian survival-time model

Abstract

Objective: To develop a Bayesian survival-time model for the prediction of pre-eclampsia (PE) at the first trimester using a combination of established biomarkers including maternal characteristics and history, mean arterial pressure (MAP), uterine artery Doppler pulsatility index (UtA-PI), and Placental Growth Factor (PlGF)) with an ophthalmic artery Doppler peak ratio (PR) analysis.

Methods: The receiving operator curve (ROC) analysis was used to determine the area under the curve (AUC), detection rate (DR), and positive screening cut-off value of the model in predicting the occurrence of early-onset PE (< 34 weeks' gestation) and preterm PE (< 37 weeks' gestation).

Results: Of the 946 eligible participants, 71 (7.49%) subjects were affected by PE. The incidences of early-onset and preterm PE were 1% and 2.2%, respectively. At a 10% false-positive rate, using the high-risk cut-off 1:49, with AUC 0.981 and 95%CI 0.965-0.998, this model had an 100% of DR in predicting early-onset PE. The DR of this model in predicting preterm PE is 71% when using 1:13 as the cut-off, with AUC 0.919 and 95%CI 0.875-0.963.

Conclusion: Combination ophthalmic artery Doppler PR with the previously established biomarkers could improve the accuracy of early and preterm PE prediction at the first trimester screening.

Keywords: Bayesian; Ophthalmic artery; Pre-eclampsia; Survival model.

Fig. 1

Ophthalmic artery Doppler assessment. At the bottom is the waveform of the ophthalmic artery obtained by pulsed Doppler illustrating the first and second peak systolic velocity

Fig. 2

Survival analysis curve of gestational age at delivery from PE and non-PE group

Fig. 3

Effect of categorical variables on gestational age at delivery with PE

Fig. 4

ROC curve of our model to predict early-onset PE (AUC =0.981, 95%CI 0.965–0.998)

Fig. 5

ROC curve of our model to predict preterm PE (AUC =0.919, 95%CI 0.875–0.963)