Predicting complications in pre-eclampsia: external validation of the fullPIERS model using the PETRA trial dataset

Joost Akkermans; Beth Payne; Peter von Dadelszen; Henk Groen; Johanna de Vries; Laura A Magee; Ben Willem Mol; Wessel Ganzevoort

doi:10.1016/j.ejogrb.2014.05.021

Predicting complications in pre-eclampsia: external validation of the fullPIERS model using the PETRA trial dataset

Eur J Obstet Gynecol Reprod Biol. 2014 Aug:179:58-62. doi: 10.1016/j.ejogrb.2014.05.021. Epub 2014 Jun 2.

Authors

Joost Akkermans¹, Beth Payne², Peter von Dadelszen², Henk Groen³, Johanna de Vries⁴, Laura A Magee⁵, Ben Willem Mol⁶, Wessel Ganzevoort⁷

Affiliations

¹ Departments of Obstetrics and Gynecology, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: j.akkermans@me.com.
² Departments of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada; The Child and Family Research Institute, University of British Columbia, Vancouver, Canada.
³ Department of Epidemiology, University of Groningen, University Medical Center, Groningen, The Netherlands.
⁴ Departments of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands.
⁵ 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.
⁶ The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia.
⁷ Departments of Obstetrics and Gynecology, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.

PMID: 24965981
DOI: 10.1016/j.ejogrb.2014.05.021

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.

Study design: 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.

Keywords: Patient care management; Pre-eclampsia; Prognosis; Validation.

MeSH terms

Eclampsia / diagnosis*
Female
Fetal Growth Retardation / diagnosis
HELLP Syndrome / diagnosis*
Humans
Pre-Eclampsia / diagnosis*
Predictive Value of Tests
Pregnancy
Pregnancy Outcome
Prognosis
Prospective Studies
ROC Curve
Risk Factors