The prediction of adverse maternal outcomes in preeclampsia.
OBJECTIVE
(1) To evaluate whether clinical variables reflecting the multiorgan dysfunctions of preeclampsia can predict adverse maternal outcomes of preeclampsia; (2) to determine the usefulness of the mean platelet volume (MPV):platelet ratio as a novel measure of platelet consumption in predicting the severity of preeclampsia.


METHODS
A retrospective chart review was conducted of cases of preeclampsia seen in 3 tertiary level units from January 2001 to December 2001. Candidate predictors of adverse maternal outcome were gestational age (GA) on admission to hospital, blood pressure, proteinuria, urine output, uric acid, creatinine, aspartate transaminase (AST), lactate dehydrogenase, bilirubin, albumin, fraction of inspired oxygen:oxygen saturation (FIO2:SaO2) ratio, platelet count, MPV, MPV:platelet ratio, fibrinogen, and seizures. The combined adverse maternal outcomes included maternal death; 1 or more of hepatic failure, hematoma, or rupture; Glasgow coma scale <13; stroke; 2 or more seizures; cortical blindness; positive inotrope support; myocardial infarction; infusion of any third antihypertensive; dialysis; renal transplantation; > or =50% FIO2 for >1 hour; intubation; or transfusion of > or =10 units of blood products. Descriptive, univariable, and multivariable analyses were performed, with significance set at P < .05.


RESULTS
Of a total of 594 women with preeclampsia, 60 (10.1%) developed at least 1 element of the combined adverse outcome; 1 of these 60 women died. The most common outcomes were increased oxygen requirements, the use of a third infused antihypertensive, and transfusion >10 units. In women who developed an adverse outcome, GA and fibrinogen were lower, and total leukocyte count, creatinine, and AST were greater. Multivariable logistic regression revealed that admission GA (odds ratio [OR], 0.91), dipstick protein (OR, 1.31), and MPV:platelet ratio (OR, 391.0) independently predicted the outcome.


CONCLUSIONS
Several promising markers were identified: admission GA, dipstick proteinuria, and the MPV:platelet ratio. MPV:platelet ratio also showed promise as a marker of platelet consumption. A prospective study is required to develop a clinical prediction model for preeclampsia.
von Dadelszen
Peter
P
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC.
Magee
Laura A
LA
Devarakonda
Rajashree M
RM
Hamilton
Trevor
T
Ainsworth
Laurie M
LM
Yin
Ruihua
R
Norena
Monica
M
Walley
Keith R
KR
Gruslin
Andrée
A
Moutquin
Jean-Marie
JM
Lee
Shoo K
SK
Russell
James A
JA
D000328:Adult; D015415:Biomarkers / Q000032:analysis; D005260:Female; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D016015:Logistic Models; D008428:Maternal Mortality; D011225:Pre-Eclampsia / Q000097:blood / Q000401:mortality* / Q000652:urine; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality / Q000652:urine; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
D015415:Biomarkers