235. Evaluation of the fullpiers model and PLGF as predictors of adverse outcomes in women with hypertensive disorders of pregnancy

Introduction - Singling out high-risk patients from the diverse hypertensive disorders of pregnancy, and not only preeclampsia, is a challenge for clinicians. The fullPIERS model is a simple and low-cost evaluation instrument using clinical variables to stratify the adverse outcomes probability of pregnant women with high-risk preeclampsia. Placental growth factor (PlGF) levels are reduced in preeclampsia and are increasingly being used as a biomarker in the assessment of this disease. Objectives - The aim of the study is to evaluate the performance of the fullPIERS model and PlGF to predict adverse outcomes in women with hypertensive disorders of pregnancy. Methods - A prospective cohort study carried out at a teaching hospital in Porto Alegre, Brazil enrolling pregnant women admitted with a systolic blood pressure ≥ 140 mmHg and/or a diastolic blood pressure ≥ 90 mmHg from the 20th week of gestation. First 48 hours of admission worst clinical and laboratory data were recorded and the development of adverse maternal and perinatal outcomes scrutinised up to 14 days. Admission maternal plasma PlGF concentrations were measured. Results – A total of 405 women were enrolled. From the 351 women included in the fullPIERS model analysis, 20 (5%) developed at least one of the combined maternal adverse outcomes. The fullPIERS model had poor outcomes discrimination at 48h [AUC 0.639 (95% CI 0.458-0.819)]. At the seventh admission day, the model’s accuracy was even lower [AUC 0.612 (95% CI 0.440-0.783)]; the model’s discriminative ability remained similar [AUC 0.637 (95% CI 0.491-0.783)] at 14 days. Calibration of the fullPIERS model was poor: slope - 0.35 (95% CI 0.08-0.62), intercept -1.13 (95%CI -2.4-0.14). PlGF analysis included 392 women. PlGF < 5th percentile predicted maternal adverse outcomes within 48h in women with gestation < 35 weeks with sensitivity of 0.80, NPV of 0.98 and AUC ROC of 0.672 (CI 95%0.5-0.9). The threshold of