title: Assessing the incremental value of blood oxygen saturation (SpO(2)) in the miniPIERS (Pre-eclampsia Integrated Estimate of RiSk) Risk Prediction Model.
abstract: OBJECTIVE
  To assess the incremental value of blood oxygen saturation (SpO(2)) as a predictor in the miniPIERS model, a risk prediction model for adverse outcomes among women with a diagnosis of hypertensive disorder of pregnancy (HDP) in low-resourced settings.
  
  
  METHODS
  Using data from a prospective cohort including 852 women admitted to hospital for a HDP, the association between SpO(2) and adverse maternal outcome was assessed using logistic regression. The miniPIERS model was recalibrated and extended to include SpO(2). The incremental value of adding SpO(2) to the model was measured using a net reclassification index (NRI), sensitivity, specificity, positive and negative predictive values, and likelihood ratios.
  
  
  RESULTS
  SpO(2) of < 93% was associated with a 30-fold increase in risk (95% CI 14 to 68) of adverse maternal outcome compared to women with SpO(2) > 97%. After recalibration and extension, the miniPIERS model including SpO(2) (vs. not including SpO(2)) had improved sensitivity (32.8% vs. 49.6%) at the cost of minimally decreased specificity (91.5% vs. 96.2%) with a NRI of 0.122.
  
  
  CONCLUSIONS
  SpO(2) is a significant independent predictor of risk in women with a HDP. Adding SpO(2) to the miniPIERS model improved the model's ability to correctly identify high-risk patients who would benefit most from interventions.
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute, Vancouver BC.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Payne
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute, Vancouver BC.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Hutcheon
authors.affiliation: Child and Family Research Institute, Vancouver BC; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver BC.
authors.forename: Dustin
authors.initials: D
authors.lastname: Dunsmuir
authors.affiliation: Department of Engineering Stellenbosch University, Stellenbosch, South Africa.
authors.forename: Garth
authors.initials: G
authors.lastname: Cloete
authors.affiliation: Child and Family Research Institute, Vancouver BC; Department of Electrical and Computer Engineering, University of British Columbia, Vancouver BC.
authors.forename: Guy
authors.initials: G
authors.lastname: Dumont
authors.affiliation: Department of Obstetrics and Gynaecology, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: David
authors.initials: D
authors.lastname: Hall
authors.affiliation: Child and Family Research Institute, Vancouver BC; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver BC.
authors.forename: Joanne
authors.initials: J
authors.lastname: Lim
authors.affiliation: Child and Family Research Institute, Vancouver BC; Department of Medicine, University of British Columbia, Vancouver BC.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Magee
authors.affiliation: Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan.
authors.forename: Rozina
authors.initials: R
authors.lastname: Sikandar
authors.affiliation: Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan.
authors.forename: Rahat
authors.initials: R
authors.lastname: Qureshi
authors.affiliation: Department of Obstetrics and Gynaecology, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: Erika van
authors.initials: EV
authors.lastname: Papendorp
authors.affiliation: Child and Family Research Institute, Vancouver BC; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver BC.
authors.forename: J
authors.initials: J
authors.lastname: Mark Ansermino
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute, Vancouver BC.
authors.forename: Peter von
authors.initials: PV
authors.lastname: Dadelszen
mesh_terms: D000328:Adult; D001785:Blood Gas Monitoring, Transcutaneous; D005260:Female; D006801:Humans; D010100:Oxygen / Q000097:blood*; D011225:Pre-Eclampsia / Q000097:blood / Q000175:diagnosis*; D011247:Pregnancy; D011446:Prospective Studies; D018570:Risk Assessment; D055815:Young Adult
chemical_list: D010100:Oxygen
keywords: preeclampsia; prognosis; pulse oximetry; recalibration