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

Detalhes bibliográficos
Autor(a) principal: Payne, Beth A.
Data de Publicação: 2014
Outros Autores: 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
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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spelling 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
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