{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:55:49Z","timestamp":1782780949559,"version":"3.54.5"},"reference-count":23,"publisher":"Georg Thieme Verlag KG","issue":"08","funder":[{"DOI":"10.13039\/100013965","name":"Eastern Virginia Medical School","doi-asserted-by":"crossref","award":["Junior Clinical Investigator Program"],"award-info":[{"award-number":["Junior Clinical Investigator Program"]}],"id":[{"id":"10.13039\/100013965","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>This study aimed to externally validate the Preeclampsia Integrated Estimate of Risk (fullPIERS) risk prediction model in a cohort of pregnant individuals with preeclampsia in the United States.<\/jats:p><jats:p>This was a retrospective study of individuals with preeclampsia who delivered at 22 weeks or greater from January 1, 2010, to December 31, 2020. The primary outcome was a composite of maternal mortality or other serious complications of preeclampsia occurring within 48\u2009hours of admission. We calculated the probability of the composite outcome using the fullPIERS prediction model based on data available within 12\u2009hours of admission, including gestational age, chest pain or dyspnea, serum creatinine levels, platelet count, aspartate transaminase levels, and oxygen saturation. We assessed the model performance using the area under the curve (AUC) of the receiver operating characteristic curve. The optimal cutoff point was determined using Liu's method. A calibration plot was used to evaluate the model's goodness-of-fit.<\/jats:p><jats:p>Among 1,510 individuals with preeclampsia, 82 (5.4%) experienced the composite outcome within 48\u2009hours. The fullPIERS model achieved an AUC of 0.80 (95% confidence interval [CI]: 0.75\u20130.86). The predicted probability for individuals with the composite outcome (median: 18.8%; interquartile range: 2.9\u201359.1) was significantly higher than those without the outcome (median: 0.9%; interquartile range: 0.4\u20132.7). The optimal cutoff point of 5.5% yielded a sensitivity of 70.7% (95% CI: 59.6\u201380.3), a specificity of 85% (95% CI: 82.7\u201386.5), a positive likelihood ratio of 4.6 (95% CI: 3.8\u20135.5), and an odds ratio of 13.3 (95% CI: 8.1\u201321.8). The calibration plot indicated that the model underestimated risk when the predicted probability was below 1% and overestimated risk when the predicted probability exceeded 5%.<\/jats:p><jats:p>The fullPIERS model demonstrated good discrimination in this U.S. cohort of individuals with preeclampsia, suggesting it may be a useful tool for health care providers to identify individuals at risk for severe complications.<\/jats:p>","DOI":"10.1055\/a-2452-8220","type":"journal-article","created":{"date-parts":[[2024,10,29]],"date-time":"2024-10-29T00:31:33Z","timestamp":1730161893000},"page":"1035-1042","source":"Crossref","is-referenced-by-count":2,"title":["External Validation of the fullPIERS Risk Prediction Model in a U.S. Cohort of Individuals with Preeclampsia"],"prefix":"10.1055","volume":"42","author":[{"given":"Danielle","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University (ODU), Norfolk, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kari","family":"Flicker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Jefferson Health \u2013 New Jersey, Cherry Hill, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya","family":"Vishnia","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University (ODU), Norfolk, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeleine","family":"Wright","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University (ODU), Norfolk, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matilda","family":"Francis","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenyone S.","family":"King","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University (ODU), Norfolk, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Gilgannon","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aref","family":"Rastegar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University (ODU), Norfolk, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neha","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University (ODU), Norfolk, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohini","family":"Kousalya Siva","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lea","family":"Nehme","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University (ODU), Norfolk, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2438-1699","authenticated-orcid":false,"given":"Tetsuya","family":"Kawakita","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University (ODU), Norfolk, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,11,25]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ejogrb.2013.05.005","article-title":"Global and regional estimates of preeclampsia and eclampsia: a systematic review","volume":"170","author":"E Abalos","year":"2013","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"15","key":"ref2","doi-asserted-by":"crossref","first-page":"f6564","DOI":"10.1136\/bmj.f6564","article-title":"Pre-eclampsia rates in the United States, 1980-2010: age-period-cohort analysis","volume":"347","author":"C V Ananth","year":"2013","journal-title":"BMJ"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1097\/AOG.0000000000000472","article-title":"Maternal morbidity associated with early-onset and late-onset preeclampsia","volume":"124","author":"S Lisonkova","year":"2014","journal-title":"Obstet Gynecol"},{"issue":"03","key":"ref4","first-page":"283","article-title":"Racial\/ethnic differences in pregnancy-related hypertensive disease in nulliparous women","volume":"24","author":"G Ghosh","year":"2014","journal-title":"Ethn Dis"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1097\/AOG.0b013e31821fd49d","article-title":"Changes in pregnancy mortality ascertainment: United States, 1999-2005","volume":"118","author":"A P MacKay","year":"2011","journal-title":"Obstet Gynecol"},{"issue":"02","key":"ref6","first-page":"1","article-title":"Pregnancy-related mortality surveillance\u2013United States, 1991\u20131999","volume":"52","author":"J Chang","year":"2003","journal-title":"MMWR Surveill Summ"},{"issue":"06","key":"ref7","first-page":"950","article-title":"Preeclampsia and fetal growth","volume":"96","author":"R A Odeg\u00e5rd","year":"2000","journal-title":"Obstet 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