fullPIERS: Pre-eclampsia Integrated Estimate of RiSk
Background
Pre-eclampsia is a leading cause of maternal deaths. These deaths mainly result from eclampsia, uncontrolled hypertension, or systemic inflammation. The fullPIERS model was developed and validated 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
The fullPIERS model was developed and internally validated 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. Performance was assessed using the area under the curve (AUC) of the receiver operating characteristic (ROC). Standard bootstrapping techniques were used to assess potential overfitting.

Findings
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.

Interpretation
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.
Research authors: Peter von Dadelszen, Beth Payne, Jing Li, J Mark Ansermino, Fiona Broughton Pipkin, Anne-Marie Côté, M Joanne Douglas, Andrée Gruslin, Jennifer A Hutcheon, K S Joseph, Phillipa M Kyle, Tang Lee, Pamela Loughna, Jennifer M Menzies, Mario Merialdi, Alexandra L Millman, M Peter Moore, Jean-Marie Moutquin, Annie B Ouellet, Graeme N Smith, James J Walker, Keith R Walley, Barry N Walters, Mariana Widmer, Shoo K Lee, James A Russel, Laura A Magee, for the PIERS study group
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The risk of adverse maternal outcomes is

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Conditional information

External validation studies showed the usefulness of the fullPIERS model in discriminating between patients at high and low risk of adverse maternal outcomes within 48 hours up to a week after assessment.

A threshold of ≥30% risk is suggested as a threshold to rule-in the outcome.

The model can be used to aid clinicans in managing women with pre-eclampsia in similar settings and to make decisions such as transfer to higher care units and delivery. 

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