Predictors of posterior reversible encephalopathy syndrome in women with hypertension in pregnancy: A prospective observational study

Abstract

Objectives: Posterior reversible encephalopathy syndrome (PRES) is a clinical neuro-radiologic abnormality associated with eclampsia and is diagnosed with magnetic resonance imaging (MRI). However, MRI scans to detect PRES may be difficult to obtain routinely. Thus, it would be useful to see whether standard demographic, clinical and laboratory parameters are predictive of PRES.

Study design: Prospective observational cohort study.

Main outcome measure: Prediction of PRES with standard parameters.

Results: 30 hypertensive pregnant women were enrolled. Brain MRI scans were performed after delivery till 7 days post-partum. Area under curves (AUC)s for clinical and laboratory parameters were generated for PRES prediction. A total of 8 women (5 with eclampsia and 3 with preeclampsia with features of severity) had PRES features in MRI. The most specific parameters for predicting PRES were age (<24 years), platelet count (<0.69 lacs/mm³), serum ALT (>129 IU/L) and AST (>55 IU/L), total bilirubin (>1.3 mg/dl), low hemoglobin (<8.7 g/dl) and presence of seizures. The most sensitive predicting parameters were serum uric acid > 5.2 mg/dl, systolic blood pressure (SBP) > 164 mm Hg, diastolic blood pressure > 100 mmHg and serum creatinine > 0.8 mg/dl. The best AUCs > 70% and good Youden indices were obtained for age < 24 years, SBP > 164 mm Hg, total bilirubin > 1.3 mg/dl, AST > 55 IU/L, hemoglobin < 8.7 mg/dl and uric acid > 5.2 mg/dl.

Conclusion: In women with preeclampsia, younger age, raised SBP, elevated serum total bilirubin, uric acid and AST and low hemoglobin best predict PRES.

Keywords: Eclampsia; Posterior reversible encephalopathy syndrome; Preeclampsia.