fullPIERS: Pre-eclampsia Integrated Estimate of RiSk (recalibrated)
Early-onset preeclampsia is associated with severe maternal and perinatal complications. The fullPIERS model (Preeclampsia Integrated Estimate of Risk) showed both internal and external validities for predicting adverse maternal outcomes within 48 hours for women admitted with preeclampsia at any gestational age. This ability to recognize women at the highest risk of complications earlier could aid in preventing these adverse outcomes through improved management. Because the majority (≈70%) of the women in the model development had late-onset preeclampsia, the performance of the fullPIERS model was assessed in women with early-onset preeclampsia to determine whether it will be useful in this subgroup of women with preeclampsia. Three cohorts of women admitted with early-onset preeclampsia between 2012 and 2016, from tertiary hospitals in Canada, the Netherlands, and United Kingdom, were used. Using the published model equation, the probability of experiencing an adverse maternal outcome was calculated for each woman, and model performance was evaluated based on discrimination, calibration, and stratification. The total data set included 1388 women, with an adverse maternal outcome rate of 7.3% within 48 hours of admission. The model had good discrimination, with an area under the receiver operating characteristic curve of 0.80 (95% confidence interval, 0.75-0.86), and a calibration slope of 0.68. The estimated likelihood ratio at the predicted probability of ≥30% was 23.4 (95% confidence interval, 14.83-36.79), suggesting a strong evidence to rule in adverse maternal outcomes. The fullPIERS model will aid in identifying women admitted with early-onset preeclampsia in similar settings who are at the highest risk of adverse outcomes, thereby allowing timely and effective interventions.
Research authors: U. Vivian Ukah, Beth Payne, Jennifer A. Hutcheon, J. Mark Ansermino, Wessel Ganzevoort, Shakila Thangaratinam, Laura A. Magee, Peter von Dadelszen
Details Formula Study characteristics Files & References
Model author
Model ID
Revision date
MeSH terms
  • Pre-Eclampsia
  • Model type
    Custom model (Calculation)

    Additional information

    The BCW, PETRA, and PREP cohorts included 218, 216, and 954 women, respectively, making a total of 1388 women admitted with preeclampsia before 34 weeks of gestation in our analytic data set. The women in the BCW cohort appeared to be older and have a higher rate of chest pain or dyspnea and more interventions during pregnancy (higher administration of corticosteroids, antihypertensive medication, and magnesium sulfate; Table 1). The PETRA cohort had the highest reported rate of the HELLP syndrome and higher rates of stillbirth and neonatal death. The PREP cohort had higher multiparity and lower use of magnesium sulfate during pregnancy. Compared with the fullPIERS development cohort, the early-onset cohorts reported more chest pain or dyspnea, higher administration of corticosteroid, shorter admission-todelivery interval, and lower birth weights.

    Study Population

    Total population size: 2023
    Males: {{ model.numberOfMales }}
    Females: {{ model.numberOfFemales }}

    Categorical characteristics

    Name Subset / Group Nr. of patients
    fullPIERS cohort (development; 2023 women) HELLP syndrome 125
    Maternal age at EDD (years) 31
    Parity ≥1 581
    Gestational age at eligibility (weeks) 36
    Multiple pregnancy 192
    Smoking in this pregnancy 249
    Systolic BP (mm Hg) 160
    Diastolic BP (mm Hg) 102
    Chest pain/dyspnoea 90
    Lowest platelet count (x10^9/L) 192
    Highest AST/ALT (U/L) 28
    Creatinine 67
    Corticosteroids 550
    Antihypertensive therapy 1381
    MgSO4 690
    Admission-to-delivery interval (days) 2
    Gestational age at delivery 36.9
    Birth weight 2141
    Stillbirth 20
    Neonatal death 20
    fullPIERS: Pre-eclampsia Integrated Estimate of RiSk (recalibrated)
    Refer to Intended Use for instructions before use
    Evidencio B.V., Irenesingel 19, 7481 GJ, Haaksbergen, the Netherlands

    The risk of adverse maternal outcomes is

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    The risk of adverse maternal outcomes is

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    Outcome stratification

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    Result interpretation

    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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    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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