title: Predicting complications in pre-eclampsia: external validation of the fullPIERS model using the PETRA trial dataset.
abstract: OBJECTIVE
  The internally validated fullPIERS model predicts adverse maternal outcomes in women with pre-eclampsia within 48h after eligibility. Our objective was to assess generalizability of this prediction model.
  
  
  METHODS
  External validation study using prospectively collected data from two tertiary care obstetric centers.
  
  
  METHODS
  The existing PETRA dataset, a cohort of women (n=216) with severe early-onset pre-eclampsia, eclampsia, HELLP syndrome or hypertension-associated fetal growth restriction was used. The fullPIERS model equation was applied to all women in the dataset using values collected within 48h after inclusion. The performance (ROC area and R-squared) of the model, risk stratification and calibration were assessed from 48h up to a week after inclusion.
  
  
  RESULTS
  Of 216 women in the PETRA trial, 73 (34%) experienced an adverse maternal outcome(s) at any time after inclusion. Adverse maternal outcome was observed in 32 (15%) cases within 48h and 62 (29%) within 7 days after inclusion. The fullPIERS model predicted adverse maternal outcomes within 48h (AUC ROC 0.97, 95% CI: 0.87-0.99) and up to 7 days after inclusion (AUC ROC 0.80, 95% CI: 0.70-0.87).
  
  
  CONCLUSIONS
  The fullPIERS model performed well when applied to the PETRA dataset. These results confirm the usability of the fullPIERS prediction model as a 'rule-in' test for women admitted with severe pre-eclampsia, eclampsia, HELLP syndrome or hypertension-associated fetal growth restriction. Future research should focus on intervention studies that assess the clinical impact of strategies using the fullPIERS model.
authors: Departments of Obstetrics and Gynecology, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: j.akkermans@me.com.
authors: Joost
authors: J
authors: Akkermans
authors: Departments of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada; The Child and Family Research Institute, University of British Columbia, Vancouver, Canada.
authors: Beth
authors: B
authors: Payne
authors: Departments of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada; The Child and Family Research Institute, University of British Columbia, Vancouver, Canada.
authors: Peter
authors: P
authors: von Dadelszen
authors: Department of Epidemiology, University of Groningen, University Medical Center, Groningen, The Netherlands.
authors: Henk
authors: H
authors: Groen
authors: Departments of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands.
authors: Johanna de
authors: Jd
authors: Vries
authors: Departments of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada; Department of Medicine, University of British Columbia, Vancouver, Canada; The Child and Family Research Institute, University of British Columbia, Vancouver, Canada.
authors: Laura A
authors: LA
authors: Magee
authors: The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia.
authors: Ben Willem
authors: BW
authors: Mol
authors: Departments of Obstetrics and Gynecology, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.
authors: Wessel
authors: W
authors: Ganzevoort
mesh_terms: D004461:Eclampsia / Q000175:diagnosis*; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis; D017359:HELLP Syndrome / Q000175:diagnosis*; D006801:Humans; D011225:Pre-Eclampsia / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors
keywords: Patient care management; Pre-eclampsia; Prognosis; Validation