Predictors of intensive care unit admission in posterior reversible encephalopathy syndrome patients with preeclampsia or eclampsia: a 10-year retrospective study

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) in pregnancy, triggered by obstetric conditions, is a neuroradiological syndrome and a critical maternal complication that is highly prevalent among women with preeclampsia (PE) or eclampsia. Sometimes, prompt, aggressive management is needed to improve outcomes. However, current knowledge of factors associated with intensive care unit (ICU) admission in pregnant PRES patients is limited. METHODS: Here, we conducted a retrospective cohort analysis of 366 pregnant women who were diagnosed with PRES with PE or eclampsia. We used multivariable logistic regression to identify clinical and imaging factors associated with ICU admission. RESULTS: Among the 366 patients, 25.7% required management in the ICU during hospitalization. We identified several independent predictors of ICU admission, including increased C-reactive protein levels (OR: 1.011, 95% CI 1.002–1.020, p = 0.015), decreased albumin levels (OR: 0.915, 95% CI 0.850–0.985, p = 0.018), elevated lactic acid levels (OR: 1.828, 95% CI 1.258–2.656, p = 0.002), altered consciousness (OR: 5.137, 95% CI 2.198–12.002, p < 0.001), and increased edema scores (OR: 1.505 95% CI 1.092–2.074, p = 0.012) by multivariate logistic regression analysis. The predictive model had high discriminatory accuracy, with an area under the ROC curve of 0.8737 (p < 0.0001). CONCLUSION: The CRP, albumin, and lactic acid levels, edema score, and presence of altered consciousness might be indicators for the prompt identification of pregnant PRES patients who require ICU admission, and per the area under the curve (AUC), the accuracy of this predictive model is good.