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fullPIERS (Pre-eclampsia Integrated Estimate of RiSk): external validation and recalibration

Background

The fullPIERS model was developed and internally validation in a cohort of 2023 women with pre-eclampsia admitted to tertiary perinatal units in Canada, the UK, New Zealand and Australia. With good stratification capacity and predictive performance (AUC ROC: 0.88), the fullPIERS model needs to be validated externally, and then recalibrated, using external datasets.

Using the 2012 CIHR Knowledge Translation Award to Peter von Dadelszen, Vivian Ukah, herself a recipient of a UBC Four Year Fellowship (FYF), has been recruited to read for her PhD by undertaking the external validation and recalibration of the fullPIERS model, including and excluding translational biomarkers.

Following baseline recalibration of the fullPIERS model using the initial dataset with novel methodology developed by Beth Payne primarily for her miniPIERS-focussed PhD thesis, the plan is to update the BC Women’s Hospital cohort of women admitted with any hypertensive disorder of pregnancy, and to import data from extant datasets that will inform the model.

One of these datasets is the Dutch PETRA (Pre-Eclampsia Trial Amsterdam) RCT that tested fluid expansion in women with pre-eclampsia. Joost Akkermans has determined that fullPIERS has an AUC ROC of 0.97 in this cohort of 216 women with severe, early-onset pre-eclampsia (data presented at ISSHP 2012 and submitted for publication). Once these this paper has been accepted for publication, the data will be integrated into the fullPIERS dataset.

Additional datasets identified to date include: the miniPIERS dataset (many cases have informative data, especially the Shanghai data excluded from the mniPIERS modelling), the HYPITAT Trial, and the Alere-funded PELICAN and PETRA studies. An application has been made to the Global Pregnancy CoLaboratory (Objective Four) to identify additional datasets that might inform the fullPIERS model.The integration of placental growth factor (PlGF) into fullPIERS will become a priority should the Brazilian Grand Challenges preterm birth operating grant be awarded (see Objective Four), as that study will use both PlGF and fullPIERS to risk stratify women with pre-eclampsia in that study.

Goal

Publication of baseline recalibration of fullPIERS in the context of a methodology paper, as well as the PETRA Trial manuscript and, potentially, the paper integrating PlGF into the model.