Abstract
Purpose of Investigation: The fullPIERS model is an effective tool to predict the adverse outcomes of pre-eclampsia. This study aimed to validate the effectiveness of fullPIERS model, and discover the variables that may be useful to predict the adverse outcomes of hypertensive disorders in pregnancy (HDPs) in Chinese population. Materials and Methods: The authors retrospectively collected the data of 1,430 HDPs patients within 48 hours of adverse outcomes in two tertiary hospitals in China. Calculated the risk probability value of every patient using fullPIERS model and validated the predictive efficiency by area under curve of operating characteristic curve (AUC ROC). To assess the factors particularly useful to predict adverse outcomes of HDPs for Chinese population, the authors conducted the independent sample t-test and multivariate regression analysis to the following factors: age, platelet count, gestational age, creatinine, AST, total bilirubin, direct bilirubin, indirect bilirubin, hemoglobin, albumin, globulin, ALT, alkaline phosphatase, lactic dehydrogenase, urea, and uric acid. Results: The AUC ROC was 0.768 calculated by fullPIERS model within 48 hours of adverse outcomes, and the cut-off probability value was 0.045. In patients with a probability value ≥ 0.045, 53.53% experienced adverse outcomes, and the false positive rate was 10.70%. Lactic dehydrogenase was a promising variable for predicting the risk of adverse outcome of HDPs. The AUC ROC calculated based on lactic dehydrogenase alone was 0.615 with a cut-off value of 243.5 U/L. Conclusions: The fullPIERS model was effective for Chinese population to predict adverse outcomes in pregnant women complicating HDPs. Lactic dehydrogenase was a promising variable to predict the adverse outcomes of HDPs.
Highlights
Hypertensive disorders in pregnancy (HDPs), including preeclampsia, eclampsia, gestational hypertension, chronic hypertension, and HELLP syndrome, complicating 5-10% of pregnancies [1], are important causes of mortality and morbidity in pregnant women
The study’s aim was to validate the effectiveness of fullPIERS model for the Chinese population, and to discover the variables which may be useful to predict the risk of adverse outcome of HDPs in this population
Some common indexes such as mean arterial pressure (MAP), roll over test (ROT), 24-hour ambulatory blood pressure monitoring, the monitoring system for hypertension, and Doppler ultrasonic monitor used clinically to predict the progress of HDPs all showed unsatisfactory effect [14]
Summary
Hypertensive disorders in pregnancy (HDPs), including preeclampsia, eclampsia, gestational hypertension, chronic hypertension, and HELLP syndrome, complicating 5-10% of pregnancies [1], are important causes of mortality and morbidity in pregnant women. No effective treatment can be used except delivery For those patients suffering remotely from term, the magnitude of the maternal risks associated with expectant management is unclear [2]. Professor Peter von Dadelszen et al at the University of British Columbia in Vancouver, Canada, developed the fullPIERS model, based on maternal demographics, signs, symptoms, and laboratory tests, to predict the risk of adverse outcome of pre-eclampsia under the collaboration of eight international centers in six years [3]. Both the internal and external validation of fullPIERS model have been proven by some studies [3-6]. The study’s aim was to validate the effectiveness of fullPIERS model for the Chinese population, and to discover the variables which may be useful to predict the risk of adverse outcome of HDPs in this population
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