A multivariable prediction model for intra-amniotic infection in patients with preterm labor and intact membranes including a point of care system that measures amniotic fluid MMP-8

December 22, 2023

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Publicated to: Journal Of Perinatal Medicine. 52 (2): 136-142 - 2024-02-26 52(2), DOI: 10.1515/jpm-2023-0405

Authors:

Cobo, Teresa; Ferrero, Silvia; Haavisto, Anna; Luokola, Paula; Sanchez-Garcia, Ana B; Sanchez-Garcia, Ana B; Bosch, Jordi; Gene, Amadeu; Murillo, Clara; Rueda, Claudia; la Presa, Bernardino Gonzalez-de; Santamaria, Susana; Ponce, Julia; Boada, David; Palacio, Montse

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Affiliations

Actim Oy - Author

Actim Oy, Espoo, Finland. - Author

BCNatal Barcelona Ctr Maternal Fetal & Neonatal Me, Hosp Clin & Hosp St Joan Deu, Inst Clin Ginecol Obstet & Neonatol, Fetal iD Fetal Med Res Ctr, Sabino Arana 1 - Author

BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clinic and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetrícia I Neonatología, Fetal i+D Fetal Medicine Research Center, Barcelona, Spain. - Author

Center for Biomedical Research on Rare Diseases (CIBER-ER), Institute of Health Carlos III (ISCIII), Madrid, Spain. - Author

CORE Laboratory, Hospital Clínic, Barcelona, Spain. - Author

Hosp Clin Barcelona, CORE Lab - Author

Hosp Clin Barcelona, Ctr Biomed Diagnost, Microbiol Dept, ISGlobal - Author

Hosp St Joan Deu, Microbiol Dept - Author

Inst Hlth Carlos III ISCIII, Ctr Biomed Res Rare Dis CIBER ER - Author

Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain. - Author

Microbiology Department, Center of Biomedical Diagnostic, Hospital Clínic of Barcelona, ISGlobal, Barcelona, Spain. - Author

Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain. - Author

Abstract

Among patients with preterm labor and intact membranes (PTL), those with intra-amniotic infection (IAI) present the highest risk of adverse perinatal outcomes. Current identification of IAI, based on microbiological cultures and/or polymerase chain reaction amplification of the 16S ribosomal RNA gene, delay diagnosis and, consequently, antenatal management. The aim to of the study was to assess the performance of a multivariable prediction model for diagnosing IAI in patients with PTL below 34.0 weeks using clinical, sonographic and biochemical biomarkers.From 2019 to 2022, we prospectively included pregnant patients admitted below 34.0 weeks with diagnosis of PTL and had undergone amniocentesis to rule in/out IAI. The main outcome was IAI, defined by a positive culture and/or 16S ribosomal RNA gene in amniotic fluid. Based on the date of admission, the sample (n=98) was divided into a derivation (2019-2020, n=49) and validation cohort (2021-2022, n=49). Logistic regression models were developed for the outcomes evaluated. As predictive variables we explored ultrasound cervical length measurement at admission, maternal C-reactive protein, gestational age, and amniotic fluid glucose and matrix metalloproteinase-8 (MMP-8) levels. The model was developed in the derivation cohort and applied to the validation cohort and diagnostic performance was evaluated. Clinical management was blinded to the model results.During the study period, we included 98 patients admitted with a diagnosis of PTL. Of these, 10 % had IAI. The final model included MMP-8 and amniotic fluid glucose levels and showed an area under the receiver operating characteristic curve to predict the risk of IAI of 0.961 (95 % confidence interval: 0.860-0.995) with a sensitivity of 75 %, specificity of 93.3 %, positive likelihood ratio (LR) of 11.3 and negative LR of 0.27 in the validation cohort.In patients with PTL, a multivariable prediction model including amniotic fluid MMP-8 and glucose levels might help in the clinical management of patients undergoing amniocentesis to rule in/out IAI, providing results within a few minutes.© 2023 Walter de Gruyter GmbH, Berlin/Boston.

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Keywords

AdultAdverse outcomeAmniocentesisAmnionAmnion fluidAmnion fluid levelAmnionitisAmniotic fluidAmniotic fluid glucoseAmniotic fluid mmp-8AmpicillinArticleAzithromycinBacterium cultureBetamethasoneBiochemical analysisC reactive proteinCeftriaxoneCervical length measurementChorioamnionitisClarithromycinClinical evaluationCohort analysisConfidence intervalControlled studyDelayed diagnosisDiagnostic test accuracy studyFemaleGentamicinGestational ageGlucoseHigh risk patientHospital admissionHumanHumansInfant, newbornIntra-amniotic infectionLogistic regression analysisMajor clinical studyMatrix metalloproteinase 8MetabolismMicrobiologyMultivariate analysisNeutrophil collagenaseNewbornNonhumanObservational studyObstetric labor, prematurePoint of care testingPoint-of-carePoint-of-care systemsPolymerase chain reactionPredictionPredictive modelPregnancyPregnancy outcomePregnant womanPremature laborPrenatal carePreterm laborPreterm labor and intact membraneProspective studyReceiver operating characteristicRisk factorRna 16sRna geneSensitivity and specificitySingle blind procedureSingle drug doseTransvaginal echography

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal JOURNAL OF PERINATAL MEDICINE due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2024 there are still no calculated indicators, but in 2023, it was in position , thus managing to position itself as a Q2 (Segundo Cuartil), in the category Pediatrics, Perinatology and Child Health. Notably, the journal is positioned en el Cuartil Q3 for the agency WoS (JCR) in the category Pediatrics.

Independientemente del impacto esperado determinado por el canal de difusión, es importante destacar el impacto real observado de la propia aportación.

Según las diferentes agencias de indexación, el número de citas acumuladas por esta publicación hasta la fecha 2026-04-03:

WoS: 5
Scopus: 1
Europe PMC: 4

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Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Finland.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Cobo Cobo, Maria Teresa) and Last Author (Palacio Riera, Montserrat).

the author responsible for correspondence tasks has been Cobo Cobo, Maria Teresa.

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