Outperformance of interleukin-6 over placental alpha microglobulin-1 to predict preterm delivery in symptomatic women.

Data de publicació: 06/08/2023 Data Ahead of Print: 06/08/2023

Autors de IIS La Fe

Alba Roca Prats

Autor
José Alberola Rubio

Autor
Isauro Rogelio Monfort Ortiz

Autor
Alfredo José Perales Marín

Autor

Autors aliens a IIS La Fe

Diaz-Martinez, Alba
Albaladejo-Belmonte, Monica
Martinez-Triguero, Maria L.
Marcos-Puig, Beatriz

Grups d'Investigació

Medicina Reproductiva

Investigador Principal

José Morales Roselló

Abstract

BACKGROUND: Threatened preterm labor is the major cause of hospital admission during second half of pregnancy. An early diagnosis is crucial for adopting pharmacological measures to reduce perinatal mortality and morbidity. Current diagnostic criteria are based on symptoms and short cervical length. However, there is a high false positive rate using these criteria, which implies an overtreatment, causing unnecessary side effects and an avoidable economic burden. OBJECTIVE: To compare the use of Placental alpha-microglobulin-1 and Interleukin-6 as vaginal biomarkers combined with cervical length and other maternal characteristics to improve the prediction of preterm delivery in symptomatic women STUDY DESIGN: A prospective observational study was conducted in women with singleton pregnancies complicated by threatened preterm labor with intact membranes at between 24+0 and 34+6 weeks of gestation. A total of 136 women were included in this study. Vaginal fluid was collected with a swab for Placental alpha-microglobulin-1 determination using PartoSureTM Test, Interleukin-6 was assessed by electrochemiluminescence immunoassay, cervical length was measured by transvaginal ultrasound and obstetric variables and newborn details were retrieved from clinical records. These characteristics were used to fit univariate binary logistic regression models to predict Time to Delivery < 7 days, Time to Delivery < 14 days, Gestational Age at Delivery = 34 weeks and Gestational Age at Delivery = 37 weeks, as well as multivariate binary logistic regression models fitted with imbalanced and balanced data. Performance of models was assessed by their F2-scores and other metrics, and the association of their variables with a risk or a protective factor was studied. RESULTS: 136 women were recruited, of whom 8 were lost to follow-up and 7 were excluded. Twenty-two of the remaining 121 patients had a Time to Delivery < 7 days and 31 had a Time to Delivery < 14 days, and 30 deliveries occurred with a Gestational Age at Delivery = 34 weeks and 55 with a Gestational Age at Delivery = 37 weeks. Univariate binary logistic regression models fitted with the log transformation of Interleukin-6 showed the greatest F2-scores in most studies, which outperformed those of models fitted with Placental alpha-microglobulin-1 (log(Interleukin-6) vs. Placental alpha-microglobulin-1 in Time to Delivery < 7 days: 0.38 vs. 0.30; Time to Delivery < 14 days: 0.58 vs. 0.29; Gestational Age at Delivery = 34 weeks: 0.56 vs. 0.29; Gestational Age at Delivery = 37 weeks: 0.61 vs. 0.16). Multivariate logistic regression models fitted with imbalanced datasets outperformed most univariate models (F2-score in Time to Delivery < 7 days: 0.63; Time to Delivery < 14 days: 0.54; Gestational Age at Delivery = 34 weeks: 0.62; Gestational Age at Delivery = 37 weeks: 0.73). The performance of prediction of multivariate models was drastically improved when datasets were balanced, and was maximum in the study Time to Delivery < 7 days (F2-score: 0.88±0.2; Positive Predictive Value: 0.86±0.02; Negative Predictive Value: 0.89±0.03). CONCLUSIONS: A multivariate assessment including Interleukin-6 may lead to a more targeted treatment, thus reducing unnecessary hospitalisation and avoiding unnecessary maternal-fetal treatment.

Dades de la publicació

ISSN/ISSNe:: 2589-9333, 2589-9333
Tipus:: Article
Pàgines:: 101125-101125
DOI:: 10.1016/j.ajogmf.2023.101125
PubMed:: 37549734
Factor d'Impacte:: 1,753 SCImago ℠
Quartil:: Q1 SCImago ℠

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Keywords

multivariate assessment; preterm birth prediction; threatened preterm labor

Campos d'Estudi

Projectes associats

APLICACION DE TECNICAS LAPLACIANAS PARA LA MONITORIZACION DE LA ACTIVIDAD ELECTRICA DEL MUSCULO LISO HUMANO:ENFASIS EN ELECTROHISTEROGRAMA (LAMOHIS)

Investigador Principal: ALFREDO JOSÉ PERALES MARÍN

LAMOHIS PLAN NACIONAL I+D+I 2008-2011 . 2010

CON-CIENCIA-YV: PILDORAS DE SALUD

FCT-13-7457_FECYT_2013 . MINISTERIO DE ECONOMIA Y COMPETITIVIDAD; FUNDACIÓN PARA LA INVESTIGACIÓN DEL HOSPITAL UNIVERSITARIO LA FE DE LA COMUNIDAD VALENCIANA . 2013