David Wright Institute of Health Research University of Exeter What should we predict Preterm PE Term PE Any PE PE within 2 weeks Gestation at delivery with PE 0050 1 in 20 Personalized distribution of ID: 926702
Download Presentation The PPT/PDF document "Competing Risks Approach" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Competing Risks Approach
David Wright
Institute of Health Research, University of Exeter
Slide2What should we predict?
Preterm PE, Term PE, Any PE, PE within 2 weeks?
Gestation at delivery with PE
Slide30.050 (1 in 20)
Personalized distribution of
gestation at delivery with PE
Risk of delivery with PE <37 weeks
assuming no other cause delivery.
Gestation at delivery with PE
Slide4Gestation at delivery with PE
0.114 (1 in 9)
0.050 (1 in 20)
0.019 (1 in 53)
Gestation at delivery with PE
0.019
0.05
0.114
Risk of delivery with PE
Personalized distribution of
gestation at delivery with PE
Slide5Two sources of information
Slide6Age
Height
Weight
Black
South Asian
Chronic hypertension
SLE / APS
In vitro
fertilization
Family history of PE
Diabetes mellitus
Parous without PE
Parous with PE
Previous pregnancy interval
0.050 (1 in 20)
Prior based on maternal factors
Gestation at delivery with PE
Wright D,
Syngelaki
A,
Akolekar
R, Poon LC, Nicolaides KH. Competing risks model in screening for preeclampsia by maternal characteristics and medical history. Am J
Obstet
Gynecol
2015;213:62.e1-10.
Slide7Average
Gestation at delivery with PE
Prior based on maternal factors
Gestation at delivery with PE
Risk of delivery with PE
Risk=0.004
Nulliparous
Diabetes
Weight=118kg
Risk=0.05
Black
Chronic hypertension
Previous PE
Risk=0.68
Gestation at delivery with PE
Slide8Gestational age at delivery with PE (weeks)
Likelihood (UTPI MoM = 1.8)
O’Gorman N, Wright D, Poon LC,
Rolnik
DL,
Syngelaki
A,
de Alvarado M
,
Carbone IF,
Dutemeyer
V,
Fiolna
M, Frick A,
Karagiotis
N,
Mastrodima
S,
De Paco
Matallana
C
,
Papaioannou
G,
Pazos
A,
Plasencia W, Nicolaides KH. Multicenter screening for preeclampsia by maternal factors and biomarkers at 11-13 weeks’ gestation: comparison to NICE guidelines and ACOG recommendations. Ultrasound
Obstet Gynecol 2017; 49:756-760.
UTPI (MoM)
24
28
32
36
40
44
48
52
56
60
64
68
72
76
80
28
32
36
40
44
48
52
56
60
64
68
72
76
80
0.1
0.2
0.5
1
2
5
10
Likelihood ratio
Gestational age at delivery with PE (weeks)
Slide9Likelihood (UTPI MoM = 0.8)
O’Gorman N, Wright D, Poon LC, Rolnik DL,
Syngelaki
A,
de Alvarado M
,
Carbone IF,
Dutemeyer
V,
Fiolna
M, Frick A,
Karagiotis
N,
Mastrodima
S,
De Paco
Matallana
C
,
Papaioannou
G,
Pazos
A,
Plasencia W, Nicolaides KH. Multicenter screening for preeclampsia by maternal factors and biomarkers at 11-13 weeks’ gestation: comparison to NICE guidelines and ACOG recommendations. Ultrasound Obstet
Gynecol 2017; 49:756-760.
UTPI (MoM)
Gestational age at delivery with PE (weeks)
24
28
32
36
40
44
48
52
56
60
64
68
72
76
80
28
32
36
40
44
48
52
56
60
64
68
72
76
80
1
2
5
10
Gestational age at delivery with PE (weeks)
Likelihood ratio
Slide10Bayes theorem
Posterior
Prior x Likelihood
Reverend Thomas Bayes: 1702 - 1761
Slide11Age
Height
Weight
Black
South Asian
Chronic hypertension
SLE / APS
In vitro
fertilization
Family history of PE
Diabetes mellitus
Parous without PE
Parous with PE
Previous pregnancy interval
0.050 (1 in 20)
Prior based on maternal factors
Gestation at delivery with PE
Wright D,
Syngelaki
A,
Akolekar
R, Poon LC, Nicolaides KH. Competing risks model in screening for preeclampsia by maternal characteristics and medical history. Am J
Obstet
Gynecol
2015;213:62.e1-10.
Slide12Gestational age at delivery with PE (weeks)
Likelihood (UTPI MoM = 1.8)
O’Gorman N, Wright D, Poon LC,
Rolnik
DL,
Syngelaki
A,
de Alvarado M
,
Carbone IF,
Dutemeyer
V,
Fiolna
M, Frick A,
Karagiotis
N,
Mastrodima
S,
De Paco
Matallana
C
,
Papaioannou
G,
Pazos
A,
Plasencia W, Nicolaides KH. Multicenter screening for preeclampsia by maternal factors and biomarkers at 11-13 weeks’ gestation: comparison to NICE guidelines and ACOG recommendations. Ultrasound
Obstet Gynecol 2017; 49:756-760.
UTPI (MoM)
24
28
32
36
40
44
48
52
56
60
64
68
72
76
80
28
32
36
40
44
48
52
56
60
64
68
72
76
80
0.1
0.2
0.5
1
2
5
10
Likelihood ratio
Gestational age at delivery with PE (weeks)
Slide13Bayes Theorem
24
28
32
36
40
44
48
52
56
60
64
68
72
76
80
28
32
36
40
44
48
52
56
60
64
68
72
76
80
37
Prior
24
28
32
36
40
44
48
52
56
60
64
68
72
76
80
28
32
36
40
44
48
52
56
60
64
68
72
76
80
0.1
0.2
0.5
1
2
5
10
UTPI MoM = 1.8
Likelihood ratio
28
32
36
40
44
48
52
56
60
64
68
72
76
80
28
32
36
40
44
48
52
56
60
64
68
72
76
80
37
Posterior
Gestational age at delivery with PE (weeks)
0.05
1 in 20
0.15
1 in 7
Slide14Bayes Theorem
24
28
32
36
40
44
48
52
56
60
64
68
72
76
80
28
32
36
40
44
48
52
56
60
64
68
72
76
80
37
Prior
UTPI MoM = 0.8
Likelihood ratio
Posterior
0.1
0.2
0.5
24
28
32
36
40
44
48
52
56
60
64
68
72
76
80
28
32
36
40
44
48
52
56
60
64
68
72
76
80
1
2
5
10
28
32
36
40
44
48
52
56
60
64
68
72
76
80
28
32
36
40
44
48
52
56
60
64
68
72
76
80
37
Gestational age at delivery with PE (weeks)
0.05
1 in 20
0.022
1 in 45
Slide15Summary
Personalised distribution gestation at delivery with PE
Prior distribution from maternal factors
Likelihood given biomarkers - any combination of biomarkers
Bayes theorem
Risk of PE before
x
weeks gestation
Risk of PE within
y
weeks of current gestation
Thank You