Assessing the Incremental Value of Blood Oxygen Saturation (SpO2) in the miniPIERS (Pre-eclampsia Integrated Estimate of RiSk) Risk Prediction Model

Abstract

Objective: To assess the incremental value of blood oxygen saturation (SpO 2 ) as a predictor in the miniPIERS model, a risk prediction model for adverse outcomes among women with a diagnosis of hypertensive disorder of pregnancy (HDP) in lowresourced settings .Methods: Using data from a prospective cohort including 852 women admitted to hospital for a HDP, the association between SpO 2 and adverse maternal outcome was assessed using logistic regression . The miniPIERS model was recalibrated and extended to include SpO 2 . The incremental value of adding SpO 2 to the model was measured using a net reclassification index (NRI), sensitivity, specificity, positive and negative predictive values, and likelihood ratios .Results: SpO 2 of < 93% was associated with a 30-fold increase in risk (95% CI 14 to 68) of adverse maternal outcome compared to women with SpO 2 > 97% . After recalibration and extension, the miniPIERS model including SpO 2 (vs . not including SpO 2 ) had improved sensitivity (32 .8% vs . 49 .6%) at the cost of minimally decreased specificity (91.5% vs. 96.2%) with a NRI of 0.122. Conclusion:SpO 2 is a significant independent predictor of risk in women with a HDP . Adding SpO 2 to the miniPIERS model improved the model's ability to correctly identify high-risk patients who would benefit most from interventions. RésuméObjectif : Évaluer la valeur cumulative de la saturation en oxygène (SaO 2 ) à titre de facteur prédictif dans le cadre du modèle miniPIERS, soit un modèle de prévision des risques en ce qui concerne les issues indésirables chez les femmes ayant obtenu un diagnostic de trouble hypertensif de la grossesse (THG) dans des milieux qui ne disposent que de faibles ressources . Méthodes

Diagnostic Performance of Placental Growth Factor in Women With Suspected Preeclampsia Attending Antenatal Facilities in Maputo, Mozambique

“…[5][6][7] Therefore, we believe that integrating PlGF with both miniPI-ERS and fullPIERS, and other candidate biomarkers such as glycosylated fibronectin, 23 is an important research priority. Also, to be globally relevant and to reduce health access inequities, the accurate measurement of PlGF needs to be made available to all cadres of health workers as a whole blood point-of-care test.…”

“…Women in their community and admitted to hospital with a hypertensive disorders of pregnancy can be assessed for actuarial risk using either the demographics-, symptom-, and sign-based miniPIERS (Pre-Eclampsia Integrated Estimate of Risk) tool, especially when supplemented by pulse oximetry 5,6 or the demographics-, symptom-, sign-, and laboratory testbased fullPIERS tool.…”

“…1 The diagnosis of the hypertensive disorders of pregnancy, especially preeclampsia, largely remains reliant on women having access to accurate blood pressure (BP) measurement, estimation of urinary protein, and testing for end organ complications. Women in their community and admitted to hospital with a hypertensive disorders of pregnancy can be assessed for actuarial risk using either the demographics-, symptom-, and sign-based miniPIERS (Pre-Eclampsia Integrated Estimate of Risk) tool, especially when supplemented by pulse oximetry 5,6 or the demographics-, symptom-, sign-, and laboratory testbased fullPIERS tool.…”

Preventing deaths due to the hypertensive disorders of pregnancy

“…To strengthen miniPIERS, we used South African and Pakistani data to recalibrate and extend miniPIERS to include SpO 2 [79]. Women with SpO 2 < 93% had a 30-fold increase in risk of adverse maternal outcome compared with those with SpO2 > 97%.…”

Medical mobile technologies – what is needed for a sustainable and scalable implementation on a global scale?

“…Such a device enables further versatility of medical mobile diagnostics particularly when coupled with predictors of risks based on predictive analytics. This is the case with the PIERS on the Move application [15,16] for risk assessment in pre-eclampsia that is currently being tested on thousands of pregnant women in Mozambique and Pakistan as part of a large initiative funded by the Bill & Melinda Gates Foundation (https://pre-empt.cfri.ca, last visited 10 November 2016). More recently, a portable smartphone-connected near-infrared spectroscopy (NIRS) device has been proposed [17] that will allow for low-cost monitoring of brain, muscle and splanchnic hemodynamics.…”