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Improving diagnostic accuracy in pregnancy with individualised, gestational age-specific reference intervals
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Dockree, Samuel, Shine, Brian, Impey, Lawrence, Mackillop, Lucy, Randeva, Harpal S. and Vatish, Manu (2022) Improving diagnostic accuracy in pregnancy with individualised, gestational age-specific reference intervals. Clinica chimica acta; international journal of clinical chemistry, 527 . pp. 56-60. doi:10.1016/j.cca.2022.01.007 ISSN 1873-3492.
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Official URL: https://doi.org/10.1016/j.cca.2022.01.007
Abstract
Investigations in pregnancy should be interpreted using pregnancy-specific reference intervals (RIs). However, because of the progressive nature of pregnancy, even pregnancy-specific RIs may not be equally representative at different gestations. We proposed that gestational age-specific RIs may increase diagnostic accuracy over those with fixed limits. The trajectory of platelets was mapped in 32,778 pregnant women, using 116,798 results. Then we evaluated the accuracy with which a low measurement in early pregnancy (<3rd centile) predicted thrombocytopaenia at term, compared to the existing limit (<150 × 10 /L). Platelets fell by 14.8% between 8 and 40 weeks. Platelets below the 3rd centile before 20 weeks predicted thrombocytopaenia at term (<100 × 10 /L) with a significantly greater degree of accuracy than a fixed limit (AUC 0.86 vs. 0.76, p = 0.004). Pregnancy-specific RIs can be defined using routinely collected hospital data, and the abundance of such freely available data enables a detailed investigation of temporal changes throughout gestation. Individualised RIs offer improved accuracy profiles, over and above those already derived specifically from pregnant populations. Clinicians should consider how this may be used to improve diagnostic accuracy for biomarkers used in current clinical practice, and those yet to be defined. [Abstract copyright: Copyright © 2022 Elsevier B.V. All rights reserved.]
| Item Type: | Journal Article | ||||||||
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine > Metabolic and Vascular Health (- until July 2016) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| SWORD Depositor: | Library Publications Router | ||||||||
| Journal or Publication Title: | Clinica chimica acta; international journal of clinical chemistry | ||||||||
| Publisher: | Elsevier | ||||||||
| ISSN: | 1873-3492 | ||||||||
| Official Date: | 15 February 2022 | ||||||||
| Dates: |
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| Volume: | 527 | ||||||||
| Page Range: | pp. 56-60 | ||||||||
| DOI: | 10.1016/j.cca.2022.01.007 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Restricted or Subscription Access |
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