Performance of the FullPIERS Model for the Determination of Maternal and Perinatal Complications in Patients with Severe Preeclampsia in Cartagena, Colombia
Article Sidebar
Main Article Content
Abstract
Objectives: To evaluate the prognostic performance of the FullPIERS (full Pre-eclampsia Integrated Estimate of RiSk) model in predicting severe maternal and perinatal complications using diagnostic performance measures such as sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve in patients with severe preeclampsia treated at Clínica Maternidad Rafael Calvo of Cartagena, Colombia, between 2022 and 2023.
Materials and Methods: A retrospective cohort study was conducted using medical records of women diagnosed with severe preeclampsia between January 2022 and December 2023. The study population consisted of pregnant women with a gestational age ≥ 20 weeks who were treated at a public second-level healthcare institution. The independent variable was the score obtained from the FullPIERS model, while the dependent variables corresponded to the occurrence of two composite outcomes. A severe maternal complication was defined as the occurrence of at least one of the following: placental abruption, eclampsia, hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, stillbirth, admission to the intensive care unit, or maternal death. A perinatal complication was defined as the occurrence of at least one of the following: intrauterine growth restriction, admission to the neonatal intensive care unit, or neonatal death. The follow-up period for outcome identification was up to 48 hours after hospital admission, according to the original definition of the model.
Results: A total of 151 women with severe preeclampsia were included, of whom 47.8% developed maternal and/or perinatal complications. A severe maternal complication occurred in 20 women (13.2%) — intensive care unit admission in 11 (7.3%), HELLP syndrome in 9 (6.0%), stillbirth in 3 (2.0%), placental abruption in 2 (1.3%) and eclampsia in 2 (1.3%), with no maternal deaths — and a perinatal complication occurred in 64 neonates (42.4%), mainly admission to the neonatal intensive care unit (35.8%) and intrauterine growth restriction (13.9%). A FullPIERS-estimated probability ≥ 1% was associated with an 11-fold higher risk of severe maternal complications [odds ratio 11.09, 95% confidence interval 3.87, 31.72] (sensitivity 55%, specificity 90.08%, PPV 45.83%, NPV 92.91%). The ROC curve showed an area under the curve of 0.781 for the prediction of severe maternal complications, whereas perinatal complications did not show statistically significant differences.
Conclusion: The FullPIERS model is useful for predicting severe maternal complications in women with severe preeclampsia. However, it was not designed to predict perinatal outcomes; therefore, related results should be interpreted as exploratory analyses rather than as evidence of the model’s predictive capacity.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
1. Ortiz EI, Herrera E, De La Torre A. Extreme maternal morbidity: a tracer event to improve the quality of obstetric care in Latin America. Colomb Med (Cali) 2019;50:286-92.
2. Velumani V, Durán CC, Hernández LS. Preeclampsia: una mirada a una enfermedad mortal. Rev Fac Med Univ Nac Auton Mex 2021;64:7-18.
3. Buelvas VM, Jaraba CR. Asociación entre los niveles de déficit de base y la aparición de disfunción orgánica múltiple en pacientes con preeclampsia severa admitidas en la clínica Gestión Salud S.A.S (Cartagena) entre el 1 de enero de 2014 hasta 31 diciembre 2016. Biociencias 2017;12:59-70.
4. Departamento Administrativo Distrital de Salud (DADIS) de Cartagena. Boletín epidemiológico morbilidad materna extrema (MME) 2024;52:1-7.
5. Chávez DG, Tejada CA, Suárez AD, Gómez CF, Cabrera FJ, Figueroa C. Preeclampsia: nuevas etiologías. Univ Salud 2010;1:146-55.
6. Agrawal S, Maitra N. Prediction of adverse maternal outcomes in preeclampsia using a risk prediction model. J Obstet Gynaecol India 2016;66:104-11.
7. El-Sayed AAF. Preeclampsia: A review of the pathogenesis and possible management strategies based on its pathophysiological derangements. Taiwan J Obstet Gynecol 2017;56:593-8.
8. Garcés-Burbano YL, Bastidas-Sánchez BE, Ijají-Piamba JE, Rodríguez-Gamboa MA, Cajas-Santana DR, Ordoñez-Mosquera OE. Predicción de complicaciones maternas en trastornos hipertensivos del embarazo. Ginecol Obstet Mex 2021;89:583-94.
9. Ukah UV, Payne B, Lee T, Magee LA, Von Dadelszen P. External validation of the FullPIERS model for predicting adverse maternal outcomes in pregnancy hypertension in low- and middle-income countries. Hypertension 2017;69:705-11.
10. Von Dadelszen P, Payne B, Li J, Ansermino JM, Pipkin FB, Côté A-M, et al. Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the FullPIERS model. Lancet 2011;377:219-27.
11. Sharma A, Suri J, Khanam Z, Pandey D, Bachani S, Sharma A. Prediction of complications of pre-eclampsia using the FullPIERS high risk predictive model. Int J Gynaecol Obstet 2023;163:983-8.
12. Universitat de Barcelona, Hospital Clínic, Hospital Sant Joan de Déu. Protocolo: Hipertensión y Gestación In: Patología Materna y Obstétrica. Fetal Medicine Barcelona, Barcelona: Centro de Medicina Maternofetal y Neonatal de Barcelona (BCNatal), 2025:1-39.
13. Cázarez-Ávalos I, García-Benavente D, Toledo-Lorenzo C, Valle-Leal J, López-Valenzuela D. Desempeño diagnóstico del modelo FullPIERS como predictor de complicaciones perinatales en pacientes con preeclampsia. Ginecol Obstet Méx 2020; 88:1-7.
14. American College of Obstetricians and Gynecologists. Gestational hypertension and preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol 2020;135:e237-e260.
15. Ukah UV, Payne B, Karjalainen H, Kortelainen E, Seed PT, Conti-Ramsden FI, et al. Temporal and external validation of the FullPIERS model for the prediction of adverse maternal outcomes in women with pre-eclampsia. Pregnancy Hypertens 2019;15: 42-50.
16. Hosmer DW, Lemeshow S. Multiple logistic regression. In: Applied logistic regression. New York: Wiley, 2000:31-46.
17. Boutot M, Margueritte F, Boukeffa N, Coste Mazeau P, Aubard Y, Gauthier T. Validation externe du modèle FullPIERS dans la pré-éclampsie à partir d’une série française de 4 ans [External validation of FullPIERS model for prediction of adverse outcomes among women with pre-eclampsia in French maternity of 2014 to 2018]. Gynecol Obstet Fertil Senol 2020;48:167-173.
18. Almeida ST, Katz L, Coutinho I, Amorim MMR. Validation of FullPIERS model for prediction of adverse outcomes among women with severe pre-eclampsia. Int J Gynaecol Obstet 2017;138:142-7.
19. Vargas HV, Acosta AG, Moreno EM. La preeclampsia: un problema de salud pública mundial. Rev Chil Obstet Ginecol 2012;77:471-6.
20. Ukah UV, Payne B, Hutcheon JA, Ansermino JM, Ganzevoort W, Thangaratinam S, et al. Assessment of the FullPIERS risk prediction model in women with early-onset preeclampsia. Hypertension 2018;71: 659-65
21. Kampruan R, Sukonpan K, Wasinghon P. Pregnancy outcomes amongst normotensive and severe preeclampsia with or without underlying chronic hypertension pregnancy. Thai J Obstet Gynaecol 2016;24:202-8.
22. Phianpiset R, Phattanachindakun B, Boriboonhirunsarn D. Prevalence, risk factors, and pregnancy outcomes of early-onset severe preeclampsia among severe preeclamptic women in Siriraj Hospital. Thai J Obstet Gynaecol 2017;25: 26-34.