Akkermans Joost, Payne Beth, von Dadelszen Peter, Groen Henk, Vries Johanna de, Magee Laura A, Mol Ben Willem, Ganzevoort Wessel
Departments of Obstetrics and Gynecology, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.
Departments of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada; The Child and Family Research Institute, University of British Columbia, Vancouver, Canada.
Eur J Obstet Gynecol Reprod Biol. 2014 Aug;179:58-62. doi: 10.1016/j.ejogrb.2014.05.021. Epub 2014 Jun 2.
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.
External validation study using prospectively collected data from two tertiary care obstetric centers.
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.
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).
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.
内部验证的全PIERS模型可在符合条件后48小时内预测子痫前期女性的不良孕产妇结局。我们的目的是评估该预测模型的通用性。
使用来自两个三级护理产科中心的前瞻性收集数据进行外部验证研究。
使用现有的PETRA数据集，该数据集为一组患有严重早发型子痫前期、子痫、HELLP综合征或高血压相关胎儿生长受限的女性（n = 216）。使用纳入后48小时内收集的值，将全PIERS模型方程应用于数据集中的所有女性。从纳入后48小时直至一周，评估模型的性能（ROC面积和R平方）、风险分层和校准情况。
在PETRA试验的216名女性中，73名（34%）在纳入后的任何时间出现了不良孕产妇结局。纳入后48小时内有32例（15%）观察到不良孕产妇结局，纳入后7天内有62例（29%）。全PIERS模型在纳入后48小时内预测不良孕产妇结局（AUC ROC 0.97，95% CI：0.87 - 0.99），在纳入后长达7天内预测不良孕产妇结局（AUC ROC 0.80，95% CI：0.70 - 0.87）。
将全PIERS模型应用于PETRA数据集时表现良好。这些结果证实了全PIERS预测模型作为重度子痫前期、子痫、HELLP综合征或高血压相关胎儿生长受限入院女性的“纳入”测试的可用性。未来的研究应侧重于评估使用全PIERS模型的策略的临床影响的干预研究。
