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A risk prediction model for the assessment and triage of women with hypertensive disorders of pregnancy in low-resourced settings: the miniPIERS (Pre-eclampsia Integrated Estimate of RiSk) multi-country prospective cohort study.

Payne, BA; Hutcheon, JA; Ansermino, JM; Hall, DR; Bhutta, ZA; Bhutta, SZ; Biryabarema, C; Grobman, WA; Groen, H; Haniff, F; et al. Payne, BA; Hutcheon, JA; Ansermino, JM; Hall, DR; Bhutta, ZA; Bhutta, SZ; Biryabarema, C; Grobman, WA; Groen, H; Haniff, F; Li, J; Magee, LA; Merialdi, M; Nakimuli, A; Qu, Z; Sikandar, R; Sass, N; Sawchuck, D; Steyn, DW; Widmer, M; Zhou, J; von Dadelszen, P; miniPIERS Study Working Group (2014) A risk prediction model for the assessment and triage of women with hypertensive disorders of pregnancy in low-resourced settings: the miniPIERS (Pre-eclampsia Integrated Estimate of RiSk) multi-country prospective cohort study. PLoS Medicine, 11 (1). https://doi.org/10.1371/journal.pmed.1001589
SGUL Authors: von Dadelszen, Peter

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Abstract

BACKGROUND: Pre-eclampsia/eclampsia are leading causes of maternal mortality and morbidity, particularly in low- and middle- income countries (LMICs). We developed the miniPIERS risk prediction model to provide a simple, evidence-based tool to identify pregnant women in LMICs at increased risk of death or major hypertensive-related complications. METHODS AND FINDINGS: From 1 July 2008 to 31 March 2012, in five LMICs, data were collected prospectively on 2,081 women with any hypertensive disorder of pregnancy admitted to a participating centre. Candidate predictors collected within 24 hours of admission were entered into a step-wise backward elimination logistic regression model to predict a composite adverse maternal outcome within 48 hours of admission. Model internal validation was accomplished by bootstrapping and external validation was completed using data from 1,300 women in the Pre-eclampsia Integrated Estimate of RiSk (fullPIERS) dataset. Predictive performance was assessed for calibration, discrimination, and stratification capacity. The final miniPIERS model included: parity (nulliparous versus multiparous); gestational age on admission; headache/visual disturbances; chest pain/dyspnoea; vaginal bleeding with abdominal pain; systolic blood pressure; and dipstick proteinuria. The miniPIERS model was well-calibrated and had an area under the receiver operating characteristic curve (AUC ROC) of 0.768 (95% CI 0.735-0.801) with an average optimism of 0.037. External validation AUC ROC was 0.713 (95% CI 0.658-0.768). A predicted probability ≥25% to define a positive test classified women with 85.5% accuracy. Limitations of this study include the composite outcome and the broad inclusion criteria of any hypertensive disorder of pregnancy. This broad approach was used to optimize model generalizability. CONCLUSIONS: The miniPIERS model shows reasonable ability to identify women at increased risk of adverse maternal outcomes associated with the hypertensive disorders of pregnancy. It could be used in LMICs to identify women who would benefit most from interventions such as magnesium sulphate, antihypertensives, or transportation to a higher level of care.

Item Type: Article
Additional Information: Copyright: © 2014 Payne et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keywords: Adult, Area Under Curve, Developing Countries, Female, Humans, Logistic Models, Pre-Eclampsia, Pregnancy, Prospective Studies, ROC Curve, Risk Assessment, Risk Factors, Young Adult, miniPIERS Study Working Group, Humans, Pre-Eclampsia, Area Under Curve, Logistic Models, Risk Assessment, Risk Factors, Prospective Studies, ROC Curve, Pregnancy, Developing Countries, Adult, Female, Young Adult, General & Internal Medicine, 11 Medical And Health Sciences
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: PLoS Medicine
Article Number: e1001589
Language: eng
Dates:
DateEvent
21 January 2014Published
Publisher License: Creative Commons: Attribution 4.0
PubMed ID: 24465185
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/107505
Publisher's version: https://doi.org/10.1371/journal.pmed.1001589

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