Prediction of Adverse Maternal Outcomes in Preeclampsia: Development and Validation of the FullPIERS Model

Abstract

ABSTRACT Maternal deaths from preeclampsia primarily result in cases with eclampsia, uncontrolled hypertension, or progressing HELLP syndrome. Delivery is the only cure for preeclampsia. Management strategies involve determination of risk factors to predict which pregnancies are at high risk for adverse maternal outcomes. Previous attempts to develop risk assessment models that could identify potential predictive risk factors for adverse outcomes occurring at any time after admission with preeclampsia have been unsuccessful. The aim of this prospective multicenter study was to develop and internally validate a preeclampsia outcome prediction model—the fullPIERS (Preeclampsia Integrated Estimate of RiSk) model that could identify serious or fatal complications in women with preeclampsia or who developed the disorder within 48 hours of hospital admission. Between 2003 and 2010, data for 2023 women from 8 international sites were entered into the fullPIERS database. The primary study outcome was maternal mortality or other serious complications of preeclampsia. A stepwise backward elimination logistic regression model incorporating routinely reported and informative variables was used to predict adverse maternal outcome. Standard methods were used to calculate the area under the curve (AUC) of the receiver operating characteristic (ROC). Of the 2023 women with preeclampsia, 261 (13%) had adverse outcomes at any time after hospital admission and 106 (5%) had adverse outcomes within 48 hours of admission. Predictors in the fullPIERS model associated with adverse maternal outcome included gestational age at eligibility, chest pain or dyspnea, oxygen saturation, creatinine, platelet counts, and aspartate transaminase. Analysis of the fullPIERS model showed that the model predicted adverse maternal outcomes within the first 48 hours of eligibility; the AUC ROC was 0.88, with a 95% confidence interval, 0.84–0.92. Additionally, fullPIERS was also predictive of adverse maternal outcomes up to 7 days after eligibility (AUC ROC >0.7). Identification of women at high risk of preeclampsia complications at 48 hours to 7 days after admission may help guide clinical care and management of these women. Over time this may lead to development of new treatments and interventions that may reduce the risk of life-altering or life-ending complications such as stroke or end-organ damage.