A Risk Prediction Model for the Assessment and Triage of Women with Hypertensive Disorders of Pregnancy in Low-Resourced Settings: The miniPIERS (Pre-eclampsia Integrated Estimate of RiSk) Multi-country Prospective Cohort Study
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Date
2014-01
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Publisher
PLOS Medicine
Abstract
Background: Pre-eclampsia/eclampsia are leading causes of maternal mortality and morbidity, particularly in low- and
middle- income countries (LMICs). We developed the miniPIERS risk prediction model to provide a simple, evidence-based
tool to identify pregnant women in LMICs at increased risk of death or major hypertensive-related complications.
Methods and Findings: From 1 July 2008 to 31 March 2012, in five LMICs, data were collected prospectively on 2,081
women with any hypertensive disorder of pregnancy admitted to a participating centre. Candidate predictors collected
within 24 hours of admission were entered into a step-wise backward elimination logistic regression model to predict a
composite adverse maternal outcome within 48 hours of admission. Model internal validation was accomplished by
bootstrapping and external validation was completed using data from 1,300 women in the Pre-eclampsia Integrated
Estimate of RiSk (fullPIERS) dataset. Predictive performance was assessed for calibration, discrimination, and stratification
capacity. The final miniPIERS model included: parity (nulliparous versus multiparous); gestational age on admission;
headache/visual disturbances; chest pain/dyspnoea; vaginal bleeding with abdominal pain; systolic blood pressure; and
dipstick proteinuria. The miniPIERS model was well-calibrated and had an area under the receiver operating characteristic
curve (AUC ROC) of 0.768 (95% CI 0.735–0.801) with an average optimism of 0.037. External validation AUC ROC was 0.713
(95% CI 0.658–0.768). A predicted probability $25% to define a positive test classified women with 85.5% accuracy.
Limitations of this study include the composite outcome and the broad inclusion criteria of any hypertensive disorder of
pregnancy. This broad approach was used to optimize model generalizability.
Conclusions: The miniPIERS model shows reasonable ability to identify women at increased risk of adverse maternal
outcomes associated with the hypertensive disorders of pregnancy. It could be used in LMICs to identify women who would
benefit most from interventions such as magnesium sulphate, antihypertensives, or transportation to a higher level of care.
Description
Keywords
Pre-eclampsia, Pregnancy, Low-Resourced, Women, Hypertensive Disorders
Citation
Payne BA, Hutcheon JA, Ansermino JM, Hall DR, Bhutta ZA, et al. (2014) A Risk Prediction Model for the Assessment and Triage of Women with Hypertensive Disorders of Pregnancy in Low-Resourced Settings: The miniPIERS (Pre-eclampsia Integrated Estimate of RiSk) Multi-country Prospective Cohort Study. PLoS Med 11(1): e1001589. doi:10.1371/journal.pmed.1001589