Impact of posterior reversible encephalopathy syndrome on outcomes in pre-eclampsia and eclampsia: a nationwide analysis.

OBJECTIVES: Preeclampsia and eclampsia (PEC) are conditions which arise after 20 weeks of gestation of pregnancy and lead to organ dysfunction, including neurological dysfunction. Posterior reversible encephalopathy syndrome (PRES) could present concurrently with PEC, but population-level data describing its impact on outcomes are limited. This study utilized a national inpatient database to examine clinical outcomes of PEC with and without concurrent PRES. STUDY DESIGN: Retrospective cohort study utilized the National Readmissions Database (NRD), 2016-2022. Included a female patient between age 18 and 55 years hospitalized while pregnant with PEC, excluding ectopic pregnancies or elective termination. Hospitalizations were stratified by PRES presence and propensity-score matched 1-to-1. MAIN OUTCOME MEASURES: Outcomes are measured by In-hospital mortality, 30- and 90-day readmission rates, cost, and length of stay. RESULTS: PEC complicated by PRES involved younger patients (median age 25 vs 29) with higher rates of epilepsy history (23.1% vs. 0.8%) and stroke (1.2% vs. 0.2%). PRES was associated with increased rates of mechanical ventilation (aOR 22.05; 95% CI 12.44-39.08), in-hospital seizures (aOR 24.40; 95% CI 16.14-36.90), and acute kidney injury (aOR 4.66; 95% CI 3.25-6.69). PEC with PRES had longer hospital stays (aRR 1.34; 95% CI 1.24-1.44) and higher costs (aRR 1.89; 95% CI 1.86-1.92). Interestingly, PEC without PRES had higher 30-day (aOR 0.52; 95% CI 0.36-0.77) and 90-day (aOR 0.63; 95% CI 0.41-0.95) readmission rates. CONCLUSION: Higher rates of in-hospital seizures and mechanical ventilation were associated with PEC hospitalizations with PRES. Early detection and aggressive management may improve outcomes.