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dc.contributor.authorSnell, Kym I. E.
dc.contributor.authorAllotey, John
dc.contributor.authorSmuk, Melanie
dc.contributor.authorHooper, Richard
dc.contributor.authorChan, Claire
dc.contributor.authorAhmed, Asif
dc.contributor.authorChappell, Lucy C.
dc.contributor.authorVon Dadelszen, Peter
dc.contributor.authorGreen, Marcus
dc.contributor.authorKenny, Louise
dc.contributor.authorKhalil, Asma
dc.contributor.authorKhan, Khalid S.
dc.contributor.authorMol, Ben W.
dc.contributor.authorMyers, Jenny
dc.contributor.authorPoston, Lucilla
dc.contributor.authorThilaganathan, Basky
dc.contributor.authorStaff, Anne C.
dc.contributor.authorSmith, Gordon C. S.
dc.contributor.authorGanzevoort, Wessel
dc.contributor.authorLaivuori, Hannele
dc.contributor.authorOdibo, Anthony O.
dc.contributor.authorArenas Ramírez, Javier
dc.contributor.authorKingdom, John
dc.contributor.authorDaskalakis, George
dc.contributor.authorFarrar, Diane
dc.contributor.authorBaschat, Ahmet A.
dc.contributor.authorSeed, Paul T.
dc.contributor.authorPrefumo, Federico
dc.contributor.authorda Silva Costa, Fabricio
dc.contributor.authorGroen, Henk
dc.contributor.authorAudibert, Francois
dc.contributor.authorMasse, Jacques
dc.contributor.authorSkråstad, Ragnhild B.
dc.contributor.authorSalvesen, Kjell Å.
dc.contributor.authorHaavaldsen, Camilla
dc.contributor.authorNagata, Chie
dc.contributor.authorRumbold, Alice R.
dc.contributor.authorHeinonen, Seppo
dc.contributor.authorAskie, Lisa M.
dc.contributor.authorSmits, Luc J. M.
dc.contributor.authorVinter, Christina A.
dc.contributor.authorMagnus, Per
dc.contributor.authorEero, Kajantie
dc.contributor.authorVilla, Pia M.
dc.contributor.authorJenum, Anne K.
dc.contributor.authorAndersen, Louise B.
dc.contributor.authorNorman, Jane E.
dc.contributor.authorOhkuchi, Akihide
dc.contributor.authorEskild, Anne
dc.contributor.authorBhattacharya, Sohinee
dc.contributor.authorMcAuliffe, Fionnuala M.
dc.contributor.authorGalindo, Alberto
dc.contributor.authorHerraiz, Ignacio
dc.contributor.authorCarbillon, Lionel
dc.contributor.authorKlipstein-Grobusch, Kerstin
dc.contributor.authorYeo, Seon Ae
dc.contributor.authorBrowne, Joyce L.
dc.contributor.authorMoons, Karel G. M.
dc.contributor.authorRiley, Richard D.
dc.contributor.authorThangaratinam, Shakila
dc.contributor.author
dc.contributor.authorKwong, Alex
dc.contributor.authorSavitri, Ary I.
dc.contributor.authorUiterwaal, Cuno S. P. M.
dc.contributor.authorStaff, Annetine C.
dc.contributor.authorOlive, Elisa L.
dc.contributor.authorRedman, Christopher
dc.contributor.authorMacleod, Maureen
dc.contributor.authorThilaganathan, Baskaran
dc.contributor.authorArenas Ramírez, Javier
dc.contributor.authorMassé, Jacques
dc.contributor.authorMagnus, Per M.
dc.contributor.authorBaschat, Ahmet
dc.contributor.authorWest, Jane
dc.contributor.authorMone, Fionnuala
dc.contributor.authorZimmerman, Peter A.
dc.contributor.authorRiddell, Catherine
dc.contributor.authorKingdom, John C.
dc.contributor.authorvan de Post, Joris
dc.contributor.authorIllanes, Sebastián E.
dc.contributor.authorHolzman, Claudia
dc.contributor.authorvan Kuijk, Sander M. J.
dc.contributor.authorChappell, Lucy
dc.contributor.authorVelauthar, Luxmi
dc.contributor.authorSeed, Paul
dc.contributor.authorvan Oostwaard, Miriam
dc.contributor.authorVerlohren, Stefan
dc.contributor.authorFerrazzi, Enrico
dc.contributor.authorBrown, Mark
dc.contributor.authorVollebregt, Karlijn C.
dc.contributor.authorTakeda, Satoru
dc.contributor.authorLangenveld, Josje
dc.contributor.authorWidmer, Mariana
dc.contributor.authorSaito, Shigeru
dc.contributor.authorCarroli, Guillermo
dc.contributor.authorOlsen, Jørn
dc.contributor.authorWolf, Hans
dc.contributor.authorZavaleta, Nelly
dc.contributor.authorEisensee, Inge
dc.contributor.authorVergani, Patrizia
dc.contributor.authorLumbiganon, Pisake
dc.contributor.authorMakrides, Maria
dc.contributor.authorFacchinetti, Fabio
dc.contributor.authorSequeira, Evan
dc.contributor.authorGibson, Robert
dc.contributor.authorFerrazzani, Sergio
dc.contributor.authorFrusca, Tiziana
dc.contributor.authorFigueiró-Filho, Ernesto A.
dc.contributor.authorLapaire, Olav
dc.contributor.authorLykke, Jacob A.
dc.contributor.authorConde-Agudelo, Agustin
dc.contributor.authorMbah, Alfred
dc.contributor.authorBetran, Ana P.
dc.contributor.authorTrogstad, Lill
dc.contributor.authorSmith, Gordon G. S.
dc.contributor.authorSteegers, Eric A. P.
dc.contributor.authorSalim, Read
dc.contributor.authorHuang, Tianhua
dc.contributor.authorAdank, Annemarijne
dc.contributor.authorZhang, Jun
dc.contributor.authorMeschino, Wendy S.
dc.contributor.authorAllen, Rebecca E.
dc.contributor.authorda Silva Costa, Fabricio
dc.contributor.authorCrowther, Caroline A.
dc.contributor.authorJørgensen, Jan S.
dc.contributor.authorForest, Jean-Claude
dc.contributor.authorGiguère, Yves
dc.contributor.authorKenny, Louise C.
dc.contributor.authorYeo, SeonAe
dc.contributor.authorGoffinet, Francois
dc.contributor.authorMcCowan, Lesley
dc.contributor.authorPajkrt, Eva
dc.contributor.authorHaddad, Bassam G.
dc.contributor.authorDekker, Gustaaf
dc.contributor.authorKleinrouweler, Emily C.
dc.contributor.authorLeCarpentier, Édouard
dc.contributor.authorRoberts, Claire T.
dc.date.accessioned2020-11-02T16:13:23Z
dc.date.available2020-11-02T16:13:23Z
dc.date.issued2020-11-02
dc.date.submitted2020-03-19
dc.identifier.others12916-020-01766-9
dc.identifier.other1766
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/312325
dc.descriptionFunder: NIHR School for Primary Care Research; doi: http://dx.doi.org/10.13039/501100013374
dc.description.abstractAbstract: Background: Pre-eclampsia is a leading cause of maternal and perinatal mortality and morbidity. Early identification of women at risk during pregnancy is required to plan management. Although there are many published prediction models for pre-eclampsia, few have been validated in external data. Our objective was to externally validate published prediction models for pre-eclampsia using individual participant data (IPD) from UK studies, to evaluate whether any of the models can accurately predict the condition when used within the UK healthcare setting. Methods: IPD from 11 UK cohort studies (217,415 pregnant women) within the International Prediction of Pregnancy Complications (IPPIC) pre-eclampsia network contributed to external validation of published prediction models, identified by systematic review. Cohorts that measured all predictor variables in at least one of the identified models and reported pre-eclampsia as an outcome were included for validation. We reported the model predictive performance as discrimination (C-statistic), calibration (calibration plots, calibration slope, calibration-in-the-large), and net benefit. Performance measures were estimated separately in each available study and then, where possible, combined across studies in a random-effects meta-analysis. Results: Of 131 published models, 67 provided the full model equation and 24 could be validated in 11 UK cohorts. Most of the models showed modest discrimination with summary C-statistics between 0.6 and 0.7. The calibration of the predicted compared to observed risk was generally poor for most models with observed calibration slopes less than 1, indicating that predictions were generally too extreme, although confidence intervals were wide. There was large between-study heterogeneity in each model’s calibration-in-the-large, suggesting poor calibration of the predicted overall risk across populations. In a subset of models, the net benefit of using the models to inform clinical decisions appeared small and limited to probability thresholds between 5 and 7%. Conclusions: The evaluated models had modest predictive performance, with key limitations such as poor calibration (likely due to overfitting in the original development datasets), substantial heterogeneity, and small net benefit across settings. The evidence to support the use of these prediction models for pre-eclampsia in clinical decision-making is limited. Any models that we could not validate should be examined in terms of their predictive performance, net benefit, and heterogeneity across multiple UK settings before consideration for use in practice. Trial registration: PROSPERO ID: CRD42015029349.
dc.languageen
dc.publisherBioMed Central
dc.rightsAttribution 4.0 International (CC BY 4.0)en
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/en
dc.subjectResearch Article
dc.subjectPre-eclampsia
dc.subjectExternal validation
dc.subjectPrediction model
dc.subjectIndividual participant data
dc.titleExternal validation of prognostic models predicting pre-eclampsia: individual participant data meta-analysis
dc.typeArticle
dc.date.updated2020-11-02T16:13:23Z
prism.issueIdentifier1
prism.publicationNameBMC Medicine
prism.volume18
dc.identifier.doi10.17863/CAM.59417
dcterms.dateAccepted2020-08-26
rioxxterms.versionofrecord10.1186/s12916-020-01766-9
rioxxterms.versionVoR
rioxxterms.licenseref.urihttps://creativecommons.org/licenses/by/4.0/
dc.identifier.eissn1741-7015
pubs.funder-project-idHealth Technology Assessment Programme (14/158/02)
pubs.funder-project-idThe UK Medical Research Council and Wellcome (102215/2/13/2)


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Attribution 4.0 International (CC BY 4.0)
Except where otherwise noted, this item's licence is described as Attribution 4.0 International (CC BY 4.0)