title: Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model.
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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  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.
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada. pvd@cw.bc.ca
authors.forename: Peter
authors.initials: P
authors.lastname: von Dadelszen
authors.forename: Beth
authors.initials: B
authors.lastname: Payne
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.forename: J Mark
authors.initials: JM
authors.lastname: Ansermino
authors.forename: Fiona
authors.initials: F
authors.lastname: Broughton Pipkin
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Côté
authors.forename: M Joanne
authors.initials: MJ
authors.lastname: Douglas
authors.forename: Andrée
authors.initials: A
authors.lastname: Gruslin
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Hutcheon
authors.forename: K S
authors.initials: KS
authors.lastname: Joseph
authors.forename: Phillipa M
authors.initials: PM
authors.lastname: Kyle
authors.forename: Tang
authors.initials: T
authors.lastname: Lee
authors.forename: Pamela
authors.initials: P
authors.lastname: Loughna
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Menzies
authors.forename: Mario
authors.initials: M
authors.lastname: Merialdi
authors.forename: Alexandra L
authors.initials: AL
authors.lastname: Millman
authors.forename: M Peter
authors.initials: MP
authors.lastname: Moore
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Moutquin
authors.forename: Annie B
authors.initials: AB
authors.lastname: Ouellet
authors.forename: Graeme N
authors.initials: GN
authors.lastname: Smith
authors.forename: James J
authors.initials: JJ
authors.lastname: Walker
authors.forename: Keith R
authors.initials: KR
authors.lastname: Walley
authors.forename: Barry N
authors.initials: BN
authors.lastname: Walters
authors.forename: Mariana
authors.initials: M
authors.lastname: Widmer
authors.forename: Shoo K
authors.initials: SK
authors.lastname: Lee
authors.forename: James A
authors.initials: JA
authors.lastname: Russell
authors.forename: Laura A
authors.initials: LA
authors.lastname: Magee
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008428:Maternal Mortality; D015233:Models, Statistical; D011225:Pre-Eclampsia / Q000401:mortality*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment