Development and internal validation of the multivariable CIPHER (Collaborative Integrated Pregnancy High-dependency Estimate of Risk) clinical risk prediction model

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dc.authoridCecatti, Jose Guilherme/0000-0003-1285-8445
dc.authoridGanzevoort, Wessel/0000-0002-7243-2115
dc.authoridYong, Paul/0000-0001-5521-3052
dc.authoridAnsermino, J Mark/0000-0001-8427-2035
dc.authoridMagee, Laura/0000-0002-1355-610X
dc.authoridWallace, Euan/0000-0002-4506-5233
dc.authoridBhutta, Zulfiqar/0000-0003-0637-599X
dc.authorwosidvon Dadelszen, Peter/AAP-7480-2021
dc.authorwosidMol, Ben/I-4526-2012
dc.authorwosidHamel, Emily Michaela/AAV-8200-2021
dc.authorwosidDemirkiran, Oktay/D-4129-2019
dc.authorwosidYong, Paul J/O-3291-2017
dc.authorwosidUkah, Ugochinyere Vivian/HTM-1108-2023
dc.authorwosidCecatti, Jose Guilherme/M-5945-2013
dc.contributor.authorPayne, Beth A.
dc.contributor.authorRyan, Helen
dc.contributor.authorBone, Jeffrey
dc.contributor.authorMagee, Laura A.
dc.contributor.authorAarvold, Alice B.
dc.contributor.authorAnsermino, J. Mark
dc.contributor.authorBhutta, Zulfiqar A.
dc.date.accessioned2024-08-04T20:45:31Z
dc.date.available2024-08-04T20:45:31Z
dc.date.issued2018
dc.departmentİnönü Üniversitesien_US
dc.description.abstractBackgroundIntensive care unit (ICU) outcome prediction models, such as Acute Physiology And Chronic Health Evaluation (APACHE), were designed in general critical care populations and their use in obstetric populations is contentious. The aim of the CIPHER (Collaborative Integrated Pregnancy High-dependency Estimate of Risk) study was to develop and internally validate a multivariable prognostic model calibrated specifically for pregnant or recently delivered women admitted for critical care.MethodsA retrospective observational cohort was created for this study from 13 tertiary facilities across five high-income and six low- or middle-income countries. Women admitted to an ICU for more than24h during pregnancy orless than6weeks post-partum from 2000 to 2012 were included in the cohort. A composite primary outcome was defined as maternal death or need for organ support for more than 7days or acute life-saving intervention. Model development involved selection of candidate predictor variables based on prior evidence of effect, availability across study sites, and use of LASSO (Least Absolute Shrinkage and Selection Operator) model building after multiple imputation using chained equations to address missing data for variable selection. The final model was estimated using multivariable logistic regression. Internal validation was completed using bootstrapping to correct for optimism in model performance measures of discrimination and calibration.ResultsOverall, 127 out of 769 (16.5%) women experienced an adverse outcome. Predictors included in the final CIPHER model were maternal age, surgery in the preceding 24h, systolic blood pressure, Glasgow Coma Scale score, serum sodium, serum potassium, activated partial thromboplastin time, arterial blood gas (ABG) pH, serum creatinine, and serum bilirubin. After internal validation, the model maintained excellent discrimination (area under the curve of the receiver operating characteristic (AUROC) 0.82, 95% confidence interval (CI) 0.81 to 0.84) and good calibration (slope of 0.92, 95% CI 0.91 to 0.92 and intercept of -0.11, 95% CI -0.13 to -0.08).ConclusionsThe CIPHER model has the potential to be a pragmatic risk prediction tool. CIPHER can identify critically ill pregnant women at highest risk for adverse outcomes, inform counseling of patients about risk, and facilitate bench-marking of outcomes between centers by adjusting for baseline risk.en_US
dc.description.sponsorshipCanadian Institutes for Health Research catalyst grant: Maternal health [H10-00654]en_US
dc.description.sponsorshipThis project was funded the Canadian Institutes for Health Research catalyst grant: Maternal health: from Pre-conception to Empty Nest grant on 1/9/2010 # H10-00654.en_US
dc.identifier.doi10.1186/s13054-018-2215-6
dc.identifier.issn1364-8535
dc.identifier.issn1466-609X
dc.identifier.pmid30373675en_US
dc.identifier.scopus2-s2.0-85055617199en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.urihttps://doi.org/10.1186/s13054-018-2215-6
dc.identifier.urihttps://hdl.handle.net/11616/98509
dc.identifier.volume22en_US
dc.identifier.wosWOS:000448777800001en_US
dc.identifier.wosqualityQ1en_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.language.isoenen_US
dc.publisherBmcen_US
dc.relation.ispartofCritical Careen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.subjectRisk prediction modelen_US
dc.subjectHigh-risk pregnancyen_US
dc.subjectMaternal mortalityen_US
dc.subjectMaternal morbidityen_US
dc.subjectCritical careen_US
dc.titleDevelopment and internal validation of the multivariable CIPHER (Collaborative Integrated Pregnancy High-dependency Estimate of Risk) clinical risk prediction modelen_US
dc.typeArticleen_US

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