Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model
Peter von Dadelszen, Beth Payne, Jing Li, J Mark Ansermino, Fiona Broughton Pipkin, Anne-Marie Côté, M Joanne Douglas, Andrée Gruslin, Jennifer A Hutcheon, K S Joseph, Phillipa M Kyle, Tang Lee, Pamela Loughna, Jennifer M Menzies, Mario Merialdi, Alexandra L Millman, M Peter Moore, Jean-Marie Moutquin, Annie B Ouellet, Graeme N Smith, James J Walker, Keith R Walley, Barry N Walters, Mariana Widmer, Shoo K Lee, James A Russell, Laura A Magee, PIERS Study Group, Daniel Johnstone, Kalie Kissoon, Samantha Benton, Jane Hofer, Winnie Lau, Lynn Bissonnette, Svetlana Shachkina, Heather Ramshaw, Jane Hayes, Amanda Green, Barbra Pullar, Claire Parker, Erika van Papendorp, Pamela Lutley, Terry Viczko, Kelly Richardson, P von Dadelszen, L A Magee, M J Douglas, K R Walley, J A Russell, S K Lee, A Gruslin, G N Smith, A M Côté, J-M Moutquin, M A Brown, G Davis, B N Walters, N Sass, T Duan, Z Zhou, S Mahajan, A Noovao, L A McCowan, P Kyle, M P Moore, S Z Bhutta, Z A Bhutta, D R Hall, D W Steyn, F Broughton Pipkin, P Loughna, S Robson, M de Swiet, J J Walker, W A Grobman, M D Lindheimer, J M Roberts, Ziguang Qu, Geoffrey Cundiff, Paula Lott, Brenda Wagner, Lynne Palmer, Sayrin Lalji, D Keith Still, Dany Hugo, Dorothy Shaw, George Tawagi, Swati Mahajan, Amanda Noovao, David Hall, D Wilhelm Steyn, Christine Biryabarema, Florence Mirembe, Annettee Nakimuli, William A Grobman, Eleni Tsigas, Peter von Dadelszen, Beth Payne, Jing Li, J Mark Ansermino, Fiona Broughton Pipkin, Anne-Marie Côté, M Joanne Douglas, Andrée Gruslin, Jennifer A Hutcheon, K S Joseph, Phillipa M Kyle, Tang Lee, Pamela Loughna, Jennifer M Menzies, Mario Merialdi, Alexandra L Millman, M Peter Moore, Jean-Marie Moutquin, Annie B Ouellet, Graeme N Smith, James J Walker, Keith R Walley, Barry N Walters, Mariana Widmer, Shoo K Lee, James A Russell, Laura A Magee, PIERS Study Group, Daniel Johnstone, Kalie Kissoon, Samantha Benton, Jane Hofer, Winnie Lau, Lynn Bissonnette, Svetlana Shachkina, Heather Ramshaw, Jane Hayes, Amanda Green, Barbra Pullar, Claire Parker, Erika van Papendorp, Pamela Lutley, Terry Viczko, Kelly Richardson, P von Dadelszen, L A Magee, M J Douglas, K R Walley, J A Russell, S K Lee, A Gruslin, G N Smith, A M Côté, J-M Moutquin, M A Brown, G Davis, B N Walters, N Sass, T Duan, Z Zhou, S Mahajan, A Noovao, L A McCowan, P Kyle, M P Moore, S Z Bhutta, Z A Bhutta, D R Hall, D W Steyn, F Broughton Pipkin, P Loughna, S Robson, M de Swiet, J J Walker, W A Grobman, M D Lindheimer, J M Roberts, Ziguang Qu, Geoffrey Cundiff, Paula Lott, Brenda Wagner, Lynne Palmer, Sayrin Lalji, D Keith Still, Dany Hugo, Dorothy Shaw, George Tawagi, Swati Mahajan, Amanda Noovao, David Hall, D Wilhelm Steyn, Christine Biryabarema, Florence Mirembe, Annettee Nakimuli, William A Grobman, Eleni Tsigas
Abstract
Background: Pre-eclampsia is a leading cause of maternal deaths. These deaths mainly result from eclampsia, uncontrolled hypertension, or systemic inflammation. We developed and validated the fullPIERS model with the aim of identifying the risk of fatal or life-threatening complications in women with pre-eclampsia within 48 h of hospital admission for the disorder.
Methods: We developed and internally validated the fullPIERS model in a prospective, multicentre study in women who were admitted to tertiary obstetric centres with pre-eclampsia or who developed pre-eclampsia after admission. The outcome of interest was maternal mortality or other serious complications of pre-eclampsia. Routinely reported and informative variables were included in a stepwise backward elimination regression model to predict the adverse maternal outcome. We assessed performance using the area under the curve (AUC) of the receiver operating characteristic (ROC). Standard bootstrapping techniques were used to assess potential overfitting.
Findings: 261 of 2023 women with pre-eclampsia had adverse outcomes at any time after hospital admission (106 [5%] within 48 h of admission). Predictors of adverse maternal outcome included gestational age, chest pain or dyspnoea, oxygen saturation, platelet count, and creatinine and aspartate transaminase concentrations. The fullPIERS model predicted adverse maternal outcomes within 48 h of study eligibility (AUC ROC 0·88, 95% CI 0·84-0·92). There was no significant overfitting. fullPIERS performed well (AUC ROC >0·7) up to 7 days after eligibility.
Interpretation: The fullPIERS model identifies women at increased risk of adverse outcomes up to 7 days before complications arise and can thereby modify direct patient care (eg, timing of delivery, place of care), improve the design of clinical trials, and inform biomedical investigations related to pre-eclampsia.
Funding: Canadian Institutes of Health Research; UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction; Preeclampsia Foundation; International Federation of Obstetricians and Gynecologists; Michael Smith Foundation for Health Research; and Child and Family Research Institute.
Copyright © 2011 Elsevier Ltd. All rights reserved.
Source: PubMed