Assessment of the fullPIERS Risk Prediction Model in Women With Early-Onset Preeclampsia

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Abstract
Early-onset preeclampsia is associated with severe maternal and perinatal complications. The fullPIERS model (Preeclampsia Integrated Estimate of Risk) showed both internal and external validities for predicting adverse maternal outcomes within 48 hours for women admitted with preeclampsia at any gestational age. This ability to recognize women at the highest risk of complications earlier could aid in preventing these adverse outcomes through improved management. Because the majority (≈70%) of the women in the model development had late-onset preeclampsia, we assessed the performance of the fullPIERS model in women with early-onset preeclampsia to determine whether it will be useful in this subgroup of women with preeclampsia. Three cohorts of women admitted with early-onset preeclampsia between 2012 and 2016, from tertiary hospitals in Canada, the Netherlands, and United Kingdom, were used. Using the published model equation, the probability of experiencing an adverse maternal outcome was calculated for each woman, and model performance was evaluated based on discrimination, calibration, and stratification. The total data set included 1388 women, with an adverse maternal outcome rate of 7.3% within 48 hours of admission. The model had good discrimination, with an area under the receiver operating characteristic curve of 0.80 (95% confidence interval, 0.75–0.86), and a calibration slope of 0.68. The estimated likelihood ratio at the predicted probability of ≥30% was 23.4 (95% confidence interval, 14.83–36.79), suggesting a strong evidence to rule in adverse maternal outcomes. The fullPIERS model will aid in identifying women admitted with early-onset preeclampsia in similar settings who are at the highest risk of adverse outcomes, thereby allowing timely and effective interventions.

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