Long Danielle, Flicker Kari, Vishnia Maya, Wright Madeleine, Francis Matilda, King Kenyone S, Gilgannon Lauren, Rastegar Aref, Gupta Neha, Kousalya Siva Rohini, Nehme Lea, Kawakita Tetsuya
Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University (ODU), Norfolk, Virginia.
Department of Obstetrics and Gynecology, Jefferson Health - New Jersey, Cherry Hill, New Jersey.
Am J Perinatol. 2025 Jun;42(8):1035-1042. doi: 10.1055/a-2452-8220. Epub 2024 Oct 28.
This study aimed to externally validate the Preeclampsia Integrated Estimate of Risk (fullPIERS) risk prediction model in a cohort of pregnant individuals with preeclampsia in the United States.This was a retrospective study of individuals with preeclampsia who delivered at 22 weeks or greater from January 1, 2010, to December 31, 2020. The primary outcome was a composite of maternal mortality or other serious complications of preeclampsia occurring within 48 hours of admission. We calculated the probability of the composite outcome using the fullPIERS prediction model based on data available within 12 hours of admission, including gestational age, chest pain or dyspnea, serum creatinine levels, platelet count, aspartate transaminase levels, and oxygen saturation. We assessed the model performance using the area under the curve (AUC) of the receiver operating characteristic curve. The optimal cutoff point was determined using Liu's method. A calibration plot was used to evaluate the model's goodness-of-fit.Among 1,510 individuals with preeclampsia, 82 (5.4%) experienced the composite outcome within 48 hours. The fullPIERS model achieved an AUC of 0.80 (95% confidence interval [CI]: 0.75-0.86). The predicted probability for individuals with the composite outcome (median: 18.8%; interquartile range: 2.9-59.1) was significantly higher than those without the outcome (median: 0.9%; interquartile range: 0.4-2.7). The optimal cutoff point of 5.5% yielded a sensitivity of 70.7% (95% CI: 59.6-80.3), a specificity of 85% (95% CI: 82.7-86.5), a positive likelihood ratio of 4.6 (95% CI: 3.8-5.5), and an odds ratio of 13.3 (95% CI: 8.1-21.8). The calibration plot indicated that the model underestimated risk when the predicted probability was below 1% and overestimated risk when the predicted probability exceeded 5%.The fullPIERS model demonstrated good discrimination in this U.S. cohort of individuals with preeclampsia, suggesting it may be a useful tool for health care providers to identify individuals at risk for severe complications. · The fullPIERS risk prediction model has not been validated in a U.S. cohort.. · The model showed good predictive accuracy (AUC: 0.80) for severe maternal complications but had calibration issues at extreme-risk levels.. · This study confirms the fullPIERS model's applicability in the United States..
本研究旨在在美国一组患有先兆子痫的孕妇队列中对先兆子痫综合风险评估（fullPIERS）风险预测模型进行外部验证。这是一项对2010年1月1日至2020年12月31日期间孕22周及以上分娩的先兆子痫患者进行的回顾性研究。主要结局是入院后48小时内发生的孕产妇死亡或先兆子痫其他严重并发症的综合情况。我们根据入院后12小时内可得的数据，包括孕周、胸痛或呼吸困难、血清肌酐水平、血小板计数、天冬氨酸转氨酶水平和血氧饱和度，使用fullPIERS预测模型计算综合结局的概率。我们使用受试者工作特征曲线的曲线下面积（AUC）评估模型性能。使用刘法确定最佳截断点。使用校准图评估模型的拟合优度。在1510例先兆子痫患者中，82例（5.4%）在48小时内出现了综合结局。fullPIERS模型的AUC为0.80（95%置信区间[CI]：0.75 - 0.86）。出现综合结局的患者的预测概率（中位数：18.8%；四分位间距：2.9 - 59.1）显著高于未出现该结局的患者（中位数：0.9%；四分位间距：0.4 - 2.7）。5.5%的最佳截断点产生的灵敏度为70.7%（95%CI：59.6 - 80.3），特异度为85%（95%CI：82.7 - 86.5），阳性似然比为4.6（95%CI：3.8 - 5.5），比值比为13.3（95%CI：8.1 - 21.8）。校准图表明，当预测概率低于1%时，模型低估风险；当预测概率超过5%时，模型高估风险。fullPIERS模型在这个美国先兆子痫患者队列中显示出良好的区分度，表明它可能是医疗保健提供者识别有严重并发症风险个体的有用工具。· fullPIERS风险预测模型尚未在美国队列中得到验证。· 该模型对严重孕产妇并发症显示出良好的预测准确性（AUC：0.80），但在极端风险水平存在校准问题。· 本研究证实了fullPIERS模型在美国的适用性。
