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Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model.

von Dadelszen, P; Payne, B; Li, J; Ansermino, JM; Broughton Pipkin, F; Côté, AM; Douglas, MJ; Gruslin, A; Hutcheon, JA; Joseph, KS; et al. von Dadelszen, P; Payne, B; Li, J; Ansermino, JM; Broughton Pipkin, F; Côté, AM; Douglas, MJ; Gruslin, A; Hutcheon, JA; Joseph, KS; Kyle, PM; Lee, T; Loughna, P; Menzies, JM; Merialdi, M; Millman, AL; Moore, MP; Moutquin, JM; Ouellet, AB; Smith, GN; Walker, JJ; Walley, KR; Walters, BN; Widmer, M; Lee, SK; Russell, JA; Magee, LA; PIERS Study Group, PIERS (2011) Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model. Lancet, 377 (9761). pp. 219-227. ISSN 1474-547X https://doi.org/10.1016/S0140-6736(10)61351-7
SGUL Authors: von Dadelszen, Peter Magee, Laura Ann

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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.

Item Type: Article
Additional Information: © 2011. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords: Adult, Female, Humans, Infant, Newborn, Maternal Mortality, Models, Statistical, Pre-Eclampsia, Pregnancy, Pregnancy Outcome, Prospective Studies, ROC Curve, Risk Assessment, PIERS Study Group, Humans, Pre-Eclampsia, Pregnancy Outcome, Maternal Mortality, Models, Statistical, Risk Assessment, Prospective Studies, ROC Curve, Pregnancy, Adult, Infant, Newborn, Female, 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: Lancet
ISSN: 1474-547X
Language: eng
Dates:
DateEvent
15 January 2011Published
Publisher License: Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0
Projects:
Project IDFunderFunder ID
UNSPECIFIEDCanadian Institutes of Health Researchhttp://dx.doi.org/10.13039/501100000024
PubMed ID: 21185591
Web of Science ID: WOS:000286696400029
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/107521
Publisher's version: https://doi.org/10.1016/S0140-6736(10)61351-7

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