(325) External validation of the fullPIERS risk prediction model in women with preeclampsia.

Thursday, February 9, 2023

10:30 AM – 12:00 PM

Objective: Hypertensive disorders of pregnancy are a leading cause of maternal morbidity and adverse pregnancy outcomes. The fullPIERS model was developed to predict severe adverse maternal outcomes within 48 hours of admission in patients with preeclampsia. This model has not been validated in the U.S cohort. We sought to examine if the fullPIERS model was predictive in the U.S cohort.

Study Design: This was a retrospective study of patients with preeclampsia who were delivered at 23 weeks or greater from January 1, 2010, to December 31, 2020. Our primary outcome was a composite of maternal mortality or other serious complications of preeclampsia that occurred within 48 hours of admission. Using the prediction model that considers gestational age at admission, chest pain or dyspnea, serum creatinine, platelet, aspartate transaminase, and oxygen saturation, we calculated the probability of the composite outcome. We assessed performance using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Hosmer-Lemeshow test was used to assess the goodness of fit.

Results:

Of 466 patients with preeclampsia, 23 (4.9%) had the composite outcome within 48 hours. The fullPIERS model had a good AUC of 0.72 (95% confidence interval 0.63-0.82) (Figure 1). However, the Hosmer-Lemeshow goodness-of-fit test showed poor calibration with P-value < 0.001. The rate of the primary outcome was similar to the predicted rates when the predicted probability was less than 10% (Table 1). However, if the predicted probability is above 10%, the model consistently overestimated the risk of the primary outcome.

Conclusion:

The fullPIERS model had good AUC in the U.S cohort of patients with preeclampsia. However, the model consistently overestimated the probability of maternal mortality or other serious complications of preeclampsia if the predicted probability is above 10%.

Primary Author(s)

Tetsuya Kawakita, MD, MS, FACOG
Assistant professor
Eastern Virginia Medical School
Norfolk, Virginia, United States

Presenting Author(s)

Rohini Kousalya Siva, MS, MPH, MS4
Medical Student
Eastern Virginia Medical School
Norfolk, Virginia, United States

Coauthor(s)

LG
Lauren Gilgannon, BS
Eastern Virginia Medical School
Norfolk, Virginia, United States
NG
Neha Gupta, BS
Eastern Virginia Medical School
Norfolk, Virginia, United States
DL
Danielle Long, BS
Eastern Virginia Medical School
Norfolk, Virginia, United States
KK
Kenyone King, BS
Eastern Virginia Medical School
Norfolk, Virginia, United States
AR
Aref Rastegar, BS
Eastern Virginia Medical School
Norfolk, Virginia, United States
MF
Matilda Francis, BS
Eastern Virginia Medical School
Norfolk, Virginia, United States
SA
Saritha Attanagoda, BS
Eastern Virginia Medical School
Norfolk, Virginia, United States
MV
Maya Vishnia, BS
Eastern Virginia Medical School
Norfolk, Virginia, United States
KF
Kari Flicker, BS
Eastern Virginia Medical School
Norfolk, Virginia, United States