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
Autor(a) principal: | |
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Data de Publicação: | 2014 |
Outros Autores: | , , , , , , , , , , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNIFESP |
Texto Completo: | http://dx.doi.org/10.1371/journal.pmed.1001589 http://repositorio.unifesp.br/handle/11600/37170 |
Resumo: | 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. |
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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 StudyBackground: 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.Univ British Columbia, Dept Obstet & Gynaecol, Vancouver, BC V5Z 1M9, CanadaUniv British Columbia, CFRI Reprod & Hlth Pregnancy Cluster, Vancouver, BC V5Z 1M9, CanadaUniv British Columbia, Sch Populat & Publ Hlth, Vancouver, BC V5Z 1M9, CanadaUniv British Columbia, Dept Anesthesiol Pharmacol & Therapeut, Vancouver, BC V5Z 1M9, CanadaUniv Stellenbosch, Dept Obstet & Gynaecol, Cape Town, South AfricaTygerberg Hosp, Cape Town, South AfricaAga Khan Univ, Ctr Excellence, Div Women & Child Hlth, Karachi, PakistanJinnah Postgrad Med Coll, Karachi, PakistanMakerere Univ, Dept Obstet & Gynecol, Kampala, UgandaNorthwestern Univ, Dept Obstet & Gynecol, Feinberg Sch Med, Chicago, IL 60611 USAUniv Groningen, Univ Med Ctr Groningen, Dept Epidemiol, Groningen, NetherlandsColonial War Mem Hosp, Dept Obstet & Gynaecol, Suva, FijiUniv British Columbia, Dept Med, Vancouver, BC, CanadaUNDP UNFPA WHO World Bank Special Programme Res D, Dept Reprod Hlth & Res RHR, Geneva, SwitzerlandAga Khan Univ, Div Women & Child Hlth, Karachi, PakistanUniversidade Federal de São Paulo, Dept Obstet & Gynaecol, São Paulo, BrazilTongji Univ, Dept Obstet, Shanghai 200092, Peoples R ChinaUniversidade Federal de São Paulo, Dept Obstet & Gynaecol, São Paulo, BrazilWeb of ScienceBill & Melinda Gates FoundationUNDP/UNFPA/WHO/World Bank Special Programme of Research, Development, and Research Training in Human ReproductionCanadian Institutes of Health ResearchPreeclampsia FoundationRockefeller FoundationUnited States Agency for International DevelopmentInternational Federation of Gynecology and ObstetricsChild and Family Research InstitutePublic Library ScienceUniv British ColumbiaUniv StellenboschTygerberg HospAga Khan UnivJinnah Postgrad Med CollMakerere UnivNorthwestern UnivUniv GroningenColonial War Mem HospUNDP UNFPA WHO World Bank Special Programme Res DUniversidade Federal de São Paulo (UNIFESP)Tongji UnivPayne, Beth A.Hutcheon, Jennifer A.Ansermino, J. MarkHall, David R.Bhutta, Zulfiqar A.Bhutta, Shereen Z.Biryabarema, ChristineGrobman, William A.Groen, HenkHaniff, FarizahLi, JingMagee, Laura A.Merialdi, MarioNakimuli, AnnetteeQu, ZiguangSikandar, RozinaSass, Nelson [UNIFESP]Sawchuck, DianeSteyn, D. WilhelmWidmer, MarianaZhou, Jianvon Dadelszen, PeterMiniPIERS Study Working Grp2016-01-24T14:34:58Z2016-01-24T14:34:58Z2014-01-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion13application/pdfhttp://dx.doi.org/10.1371/journal.pmed.1001589Plos Medicine. San Francisco: Public Library Science, v. 11, n. 1, 13 p., 2014.10.1371/journal.pmed.1001589WOS000337975600008.pdf1549-1676http://repositorio.unifesp.br/handle/11600/37170WOS:000337975600008engPlos Medicineinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP2024-07-31T17:40:11Zoai:repositorio.unifesp.br/:11600/37170Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestbiblioteca.csp@unifesp.bropendoar:34652024-07-31T17:40:11Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false |
dc.title.none.fl_str_mv |
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 |
title |
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 |
spellingShingle |
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 Payne, Beth A. |
title_short |
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 |
title_full |
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 |
title_fullStr |
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 |
title_full_unstemmed |
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 |
title_sort |
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 |
author |
Payne, Beth A. |
author_facet |
Payne, Beth A. Hutcheon, Jennifer A. Ansermino, J. Mark Hall, David R. Bhutta, Zulfiqar A. Bhutta, Shereen Z. Biryabarema, Christine Grobman, William A. Groen, Henk Haniff, Farizah Li, Jing Magee, Laura A. Merialdi, Mario Nakimuli, Annettee Qu, Ziguang Sikandar, Rozina Sass, Nelson [UNIFESP] Sawchuck, Diane Steyn, D. Wilhelm Widmer, Mariana Zhou, Jian von Dadelszen, Peter MiniPIERS Study Working Grp |
author_role |
author |
author2 |
Hutcheon, Jennifer A. Ansermino, J. Mark Hall, David R. Bhutta, Zulfiqar A. Bhutta, Shereen Z. Biryabarema, Christine Grobman, William A. Groen, Henk Haniff, Farizah Li, Jing Magee, Laura A. Merialdi, Mario Nakimuli, Annettee Qu, Ziguang Sikandar, Rozina Sass, Nelson [UNIFESP] Sawchuck, Diane Steyn, D. Wilhelm Widmer, Mariana Zhou, Jian von Dadelszen, Peter MiniPIERS Study Working Grp |
author2_role |
author author author author author author author author author author author author author author author author author author author author author author |
dc.contributor.none.fl_str_mv |
Univ British Columbia Univ Stellenbosch Tygerberg Hosp Aga Khan Univ Jinnah Postgrad Med Coll Makerere Univ Northwestern Univ Univ Groningen Colonial War Mem Hosp UNDP UNFPA WHO World Bank Special Programme Res D Universidade Federal de São Paulo (UNIFESP) Tongji Univ |
dc.contributor.author.fl_str_mv |
Payne, Beth A. Hutcheon, Jennifer A. Ansermino, J. Mark Hall, David R. Bhutta, Zulfiqar A. Bhutta, Shereen Z. Biryabarema, Christine Grobman, William A. Groen, Henk Haniff, Farizah Li, Jing Magee, Laura A. Merialdi, Mario Nakimuli, Annettee Qu, Ziguang Sikandar, Rozina Sass, Nelson [UNIFESP] Sawchuck, Diane Steyn, D. Wilhelm Widmer, Mariana Zhou, Jian von Dadelszen, Peter MiniPIERS Study Working Grp |
description |
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. |
publishDate |
2014 |
dc.date.none.fl_str_mv |
2014-01-01 2016-01-24T14:34:58Z 2016-01-24T14:34:58Z |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.1371/journal.pmed.1001589 Plos Medicine. San Francisco: Public Library Science, v. 11, n. 1, 13 p., 2014. 10.1371/journal.pmed.1001589 WOS000337975600008.pdf 1549-1676 http://repositorio.unifesp.br/handle/11600/37170 WOS:000337975600008 |
url |
http://dx.doi.org/10.1371/journal.pmed.1001589 http://repositorio.unifesp.br/handle/11600/37170 |
identifier_str_mv |
Plos Medicine. San Francisco: Public Library Science, v. 11, n. 1, 13 p., 2014. 10.1371/journal.pmed.1001589 WOS000337975600008.pdf 1549-1676 WOS:000337975600008 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Plos Medicine |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
13 application/pdf |
dc.publisher.none.fl_str_mv |
Public Library Science |
publisher.none.fl_str_mv |
Public Library Science |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UNIFESP instname:Universidade Federal de São Paulo (UNIFESP) instacron:UNIFESP |
instname_str |
Universidade Federal de São Paulo (UNIFESP) |
instacron_str |
UNIFESP |
institution |
UNIFESP |
reponame_str |
Repositório Institucional da UNIFESP |
collection |
Repositório Institucional da UNIFESP |
repository.name.fl_str_mv |
Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP) |
repository.mail.fl_str_mv |
biblioteca.csp@unifesp.br |
_version_ |
1814268444307095552 |