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. 2020 Nov 5;20(1):668.
doi: 10.1186/s12884-020-03332-w.

Placental growth factor for the prognosis of women with preeclampsia (fullPIERS model extension): context matters

U Vivian Ukah  1 , Beth A Payne  2   3 , Jennifer A Hutcheon  2   4 , Lucy C Chappell  5 , Paul T Seed  5 , Frances Inez Conti-Ramsden  5 , J Mark Ansermino  2   6 , Laura A Magee  5 , Peter von Dadelszen  5 ; fullPIERS Group
Affiliations

Placental growth factor for the prognosis of women with preeclampsia (fullPIERS model extension): context matters

U Vivian Ukah et al. BMC Pregnancy Childbirth. .

Abstract

Background: The fullPIERS risk prediction model was developed to identify which women admitted with confirmed diagnosis of preeclampsia are at highest risk of developing serious maternal complications. The model discriminates well between women who develop (vs. those who do not) adverse maternal outcomes. It has been externally validated in several populations. We assessed whether placental growth factor (PlGF), a biomarker associated with preeclampsia risk, adds incremental value to the fullPIERS model.

Methods: Using a cohort of women admitted into tertiary hospitals in well-resourced settings (the USA and Canada), between May 2010 to February 2012, we evaluated the incremental value of PlGF added to fullPIERS for prediction of adverse maternal outcomes within 48 h after admission with confirmed preeclampsia. The discriminatory performance of PlGF and the fullPIERS model were assessed in this cohort using the area under the receiver's operating characteristic curve (AUROC) while the extended model (fullPIERS +PlGF) was assessed based on net reclassification index (NRI) and integrated discrimination improvement (IDI) performances.

Results: In a cohort of 541 women delivered shortly (< 1 week) after presentation, 8.1% experienced an adverse maternal outcome within 48 h of admission. Prediction of adverse maternal outcomes was not improved by addition of PlGF to fullPIERS (NRI: -8.7, IDI - 0.06). Discriminatory performance (AUROC) was 0.67 [95%CI: 0.59-0.75] for fullPIERS only and 0.67 [95%CI: 0.58-0.76]) for fullPIERS extended with PlGF, a performance worse than previously documented in fullPIERS external validation studies (AUROC > 0.75).

Conclusions: While fullPIERS model performance may have been affected by differences in healthcare context between this study cohort and the model development and validation cohorts, future studies are required to confirm whether PlGF adds incremental benefit to the fullPIERS model for prediction of adverse maternal outcomes in preeclampsia in settings where expectant management is practiced.

Keywords: Hypertension; Maternal health; Model extension; Placental growth factor; Prediction; Preeclampsia; Prognosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow showing identification of study population
Fig. 2
Fig. 2
Prediction of adverse maternal outcomes using (i) only PlGF (0.60 (95% CI 0.52–0.68)) (ii) original fullPIERS (fp) model (0.67 (95% CI 0.58–0.76)) and (iii) the extended fullPIERS model (0.67 (95% CI 0.59–0.75)) in the extension cohort
Fig. 3
Fig. 3
Discrimination slopes for (a) Original model (without PlGF) and (b) Extended model with PlGF (IDI = − 0.06) in the extension cohort
See this image and copyright information in PMC

References

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