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; Hutcheon, Jennifer A.; Ansermino, J. Mark; Hall, David; Bhutta, Zulfiqar Ahmed; Bhutta, Shereen; Biryabarema, Christine; Grobman, William A.; Groen, Henk; Haniff, F.; Li, Jing; Magee, Laura A.; Merialdi, Mario; Nakimuli, Annettee; Qu, Zhi; Sikandar, Rozina; Sass, Nelson; Sawchuck, Diane; Steyn, D. W.; Widmer, Mariana; Zhou, Jian; Dadelszen, Peter von

doi:10.1371/journal.pmed.1001589

Cited by 179 publications

(207 citation statements)

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“…34,35 Our study, which to our knowledge is likely the largest cohort to date of prospectively collected patients with CKD, aimed to assess the main determinants of risk in pregnancy. Renal function matters, and a stepwise increase in the risk of adverse maternal-fetal outcomes is observed from stage 1 to stages 4-5.…”

Section: ) Results For Both Turin Andmentioning

confidence: 99%

“…35 eGFR was calculated on preconception data, when available within 3 months before conception (38% of the cases in Torino and 57% in Cagliari) or on data at first check-up in pregnancy, employing the Cockcroft-Gault, Modification of Diet in Renal Disease, and Chronic Kidney Disease Epidemiology Collaboration formulas; the latter was chosen on account of its wider use. 36,[40][41][42] After referral, creatinine clearance and proteinuria were assessed on 24-hour urine collection.…”

Section: Definitions and Main Clinical Indicationsmentioning

confidence: 99%

“…35 Prenatal and intrapartum care of low-risk pregnancies followed the current guidelines. 43,44 The frequency of nephrologic and obstetric visits was tailored to patients with CKD, ranging from one visit every 4-6 weeks in nonhypertensive, nonproteinuric, nonsystemic patients with stage 1 CKD to one to two times weekly in patients with severe proteinuria or hypertension or stages 4-5 CKD, alone or combined.…”

Section: Definitions and Main Clinical Indicationsmentioning

confidence: 99%

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Risk of Adverse Pregnancy Outcomes in Women with CKD

Piccoli¹,

Cabiddu²,

Attini³

et al. 2015

Journal of the American Society of Nephrology

299

335

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CKD is increasingly prevalent in pregnancy. In the Torino-Cagliari Observational Study (TOCOS), we assessed whether the risk for adverse pregnancy outcomes is associated with CKD by comparing pregnancy outcomes of 504 pregnancies in women with CKD to outcomes of 836 low-risk pregnancies in women without CKD. The presence of hypertension, proteinuria (.1 g/d), systemic disease, and CKD stage (at referral) were assessed at baseline. The following outcomes were studied: cesarean section, preterm delivery, and early preterm delivery; small for gestational age (SGA); need for neonatal intensive care unit (NICU); new onset of hypertension; new onset/doubling of proteinuria; CKD stage shift; "general" combined outcome (preterm delivery, NICU, SGA); and "severe" combined outcome (early preterm delivery, NICU, SGA). The risk for adverse outcomes increased across stages (for stage 1 versus stages 4-5: "general" combined outcome, 34.1% versus 90.0%; "severe" combined outcome, 21.4% versus 80.0%; P,0.001). In women with stage 1 CKD, preterm delivery was associated with baseline hypertension (odds ratio [OR], 3.42; 95% confidence interval [95% CI], 1.87 to 6.21), systemic disease (OR, 3.13; 95% CI, 1.51 to 6.50), and proteinuria (OR, 3.69; 95% CI, 1.63 to 8.36). However, stage 1 CKD remained associated with adverse pregnancy outcomes (general combined outcome) in women without baseline hypertension, proteinuria, or systemic disease (OR, 1.88; 95% CI, 1.27 to 2.79). The risk of intrauterine death did not differ between patients and controls. Findings from this prospective study suggest a "baseline risk" for adverse pregnancy-related outcomes linked to CKD.

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Section: ) Results For Both Turin Andmentioning

confidence: 99%

Section: Definitions and Main Clinical Indicationsmentioning

confidence: 99%

Section: Definitions and Main Clinical Indicationsmentioning

confidence: 99%

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Risk of Adverse Pregnancy Outcomes in Women with CKD

Piccoli¹,

Cabiddu²,

Attini³

et al. 2015

Journal of the American Society of Nephrology

299

335

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“…Using a combination of maternal demographics, signs, symptoms, and laboratory findings, the fullPIERS model can successfully identify women at risk for preeclampsia complications so that they can access appropriate care 2 ; the miniPIERS model uses solely demographics, symptoms, and signs. 3 A frequently reported laboratory finding in women with preeclampsia is elevated serum uric acid. Most accept that hyperuricemia in women with preeclampsia is primarily a result of a reduction in glomerular filtration rate, although others have suggested a possible role for elevated uric acid levels in the pathogenesis of preeclampsia, via endothelial dysfunction.…”

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confidence: 99%

Uric Acid as a Predictor of Adverse Maternal and Perinatal Outcomes in Women Hospitalized With Preeclampsia

Livingston

Payne

Brown

et al. 2014

Journal of Obstetrics and Gynaecology Canada

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Objective: Elevated serum uric acid is commonly observed in women with preeclampsia, but its utility in predicting adverse outcomes has recently been disputed. Our goal was to analyze data from a large cohort of women with preeclampsia to determine the utility of serum uric acid in predicting adverse maternal and perinatal outcomes .Methods: Data were obtained from an ongoing international prospective study of women admitted to hospital with preeclampsia (Pre-eclampsia Integrated Estimate of RiSk). Univariate logistic regression was used to determine the relationship between serum uric acid concentration (both absolute and gestational-age corrected [Z score]) and adverse outcomes (maternal and perinatal). Analyses were conducted to compare cohorts of women with preeclampsia as defined by hypertension and proteinuria versus hypertension and hyperuricemia.Results: Uric acid Z score was associated with adverse perinatal outcome (OR 1.5; 95% CI 1.4 to 1.7) and had a point estimate > 0.7 (area under the curve receiver operating characteristic 0.72; 95% CI 0.69 to 0.74). Serum uric acid concentration also showed a significant association with adverse maternal outcomes, but the point estimate was < 0.7. No significant differences were observed between groups in which preeclampsia was defined by hypertension and proteinuria and by hypertension and hyperuricemia. Conclusion:In women admitted to hospital with preeclampsia, the serum uric acid concentration, corrected for gestational age via a Z score, is clinically useful in predicting adverse perinatal outcomes but not maternal outcomes . Résultats : Le score Z quant à l'acide urique était associé à des issues périnatales indésirables (RC, 1,5; IC à 95 %, 1,4 -1,7) et comptait une estimation ponctuelle > 0,7 (surface sous la courbe OCTOBER JOGC OCTOBRE 2014 l 871 Uric Acid as a Predictor of Adverse Maternal and Perinatal Outcomes in Women hospitalized With Preeclampsiade la fonction d 'efficacité de l'observateur, 0,72; IC à 95 %, 0,74). Une association significative a également été constatée entre la concentration sérique en acide urique et des issues indésirables maternelles; toutefois, l'estimation ponctuelle était < 0,7. Aucune différence significative n'a été constatée entre les groupes « prééclampsie définie par l'hypertension et la protéinurie » et « prééclampsie définie par l'hypertension et l'hyperuricémie ». Conclusion :Bien que la concentration sérique en acide urique (corrigée en fonction de l'âge gestationnel par l'intermédiaire d'un score Z) soit utile sur le plan clinique pour ce qui est de la prévision des issues indésirables périnatales chez les femmes hospitalisées présentant une prééclampsie, elle ne compte pas une utilité semblable en ce qui concerne les issues indésirables maternelles .

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“…The World Health Organization (WHO) estimates that PE/E accounts for at least 16% of maternal deaths in lowresource settings (LRS), which constitutes 63,000 deaths each year [2]. The increased burden of adverse outcomes in low-and middle-income countries is believed to be due primarily to the absence of trained health professionals, delays in triage, transport, and treatment [3].…”

Section: Introductionmentioning

confidence: 99%

Towards biomarker-based tests that can facilitate decisions about prevention and management of preeclampsia in low-resource settings

Acestor

Goett

Lee

et al. 2016

Clinical Chemistry and Laboratory Medicine (CCLM)

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Abstract:In recent years, an increasing amount of literature is emerging on candidate urine and blood-based biomarkers associated with incidence and severity of preeclampsia (PE) in pregnant women. While enthusiasm on the usefulness of several of these markers in predicting PE is evolving, essentially all work so far has focused on the needs of high-resource settings and high-income countries, resulting primarily in multi-parameter laboratory assays based on proteomic and metabolomics analysis techniques. These highly complex methods, however, require laboratory capabilities that are rarely available or affordable in low-resource settings (LRS). The importance of quantifying maternal and perinatal risks and identifying which pregnancies can be safely prolonged is also much greater in LRS, where intensive care facilities that can rapidly respond to PE-related health threats for women and infants are limited. For these reasons, simple, low cost, sensitive, and specific point-of-care (POC) tests are needed that can be performed by antenatal health care providers in LRS and that can facilitate decisions about detection and management of PE. Our study aims to provide a comprehensive systematic review of current and emerging blood and urine biomarkers for PE, not only on the basis of their clinical performance, but also of their suitability to be used in LRS-compatible test formats, such as lateral flow and other variants of POC rapid assays.

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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 Study

Cited by 179 publications

References 24 publications

Risk of Adverse Pregnancy Outcomes in Women with CKD

Risk of Adverse Pregnancy Outcomes in Women with CKD

Uric Acid as a Predictor of Adverse Maternal and Perinatal Outcomes in Women Hospitalized With Preeclampsia

Towards biomarker-based tests that can facilitate decisions about prevention and management of preeclampsia in low-resource settings

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