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Vol. 45. Issue 3.
Pages 156-163 (April 2021)
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Vol. 45. Issue 3.
Pages 156-163 (April 2021)
Original
DOI: 10.1016/j.medine.2021.01.002
Comparison of four prognostic scales for predicting mortality in patients with severe maternal morbidity
Comparación de 4 escalas pronósticas para predecir mortalidad en pacientes con morbilidad materna severa
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B. Jonguitud Lópeza,
Corresponding author
jl_bal@hotmail.com

Corresponding author.
, D. Álvarez Laraa, M.A. Sosa Medellínb, F. Montoya Barajasa, G.C. Palacios Saucedoc
a Unidad de Cuidados Intensivos, Hospital de especialidades en la Unidad Médica de Alta Especialidad N.º 25, IMSS, Monterrey, Nuevo León, Mexico
b Unidad de Cuidados Intensivos, Hospital de Traumatología y Ortopedia de la Unidad Médica de Alta Especialidad N.º 21, IMSS, Monterrey, Nuevo León, Mexico
c Departamento de Ense˜nanza, Hospital de especialidades en la Unidad Médica de Alta Especialidad N.º 25, IMSS, Monterrey, Nuevo León, Mexico
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Tables (3)
Table 1. Clinical characteristics, type of admission, APACHE II-M, O-SOFA, APACHE II, SOFA scores, and findings in 141 patients with severe maternal morbidity in survivors vs non-survivors.
Table 2. Causes of obstetric morbidity at admission, deaths, and lethality by diagnosis in 141 patients with severe maternal morbidity.
Table 3. Characteristics of the APACHE II-M, APACHE II, O-SOFA, and SOFA predictive models in the assessment of 141 patients with severe obstetric morbidity.
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Abstract
Objective

To compare the prognostic validity of the APACHE II-M and O-SOFA scales versus the APACHE II and SOFA to predict mortality in patients with severe maternal morbidity.

Design

A retrospective, longitudinal and analytical cohort study was carried out.

Setting

Medical-surgical intensive care unit (ICU) of a tertiary hospital.

Patients

Pregnant or puerperal patients of any age admitted to the ICU.

Interventions

Calculation of prognostic scores upon admission.

Variables of interest

APACHE II, SOFA, APACHE II-M and O-SOFA scores and maternal mortality.

Results

A total of 141 patients were included. The majority (70.2%) were puerperal. The most frequent diagnosis was gestational hypertensive disease (50 cases). The discrimination of each prognostic model was estimated with the area under the ROC curve (AUC-ROC). The calibration was estimated using the mortality ratio and the Hosmer-Lemeshow statistic. The four scales discriminated between survivors and non-survivors with areas under the curve > 0.85. The APACHE II-M model was the predictive model with the highest discrimination and calibration. In the Hosmer-Lemeshow regression analysis, mortality as predicted by the APACHE II and O-SOFA was significantly different from the observed mortality.

Conclusions

The APACHE II-M exhibited the greatest prognostic validity in predicting maternal mortality. This difference was given by its improvement in calibration.

Keywords:
Predictive scoring systems
Maternal mortality
Severe maternal morbidity
Near miss
Intensive care unit
Resumen
Objetivo

Comparar la validez pronóstica del APACHE II-M y O-SOFA versus el APACHE II y SOFA para predecir mortalidad en pacientes con morbilidad materna severa.

Diseño

Estudio de cohorte, retrospectivo, longitudinal y analítico.

Ámbito

Unidad de cuidados intensivos (UCI) médico-quirúrgica de un hospital de tercer nivel.

Pacientes

pacientes embarazadas o puérperas de cualquier edad ingresadas a la UCI.

Intervenciones

cálculo de escores pronósticos al ingreso.

Variables de interés

APACHE II, SOFA, APACHE II-M, O-SOFA y mortalidad materna.

Resultados

Se incluyeron 141 pacientes. Noventa y nueve (70.2%) fueron puérperas. El diagnóstico más frecuente fue la enfermedad hipertensiva del embarazo (50 casos). La discriminación de cada modelo pronóstico se estimó con el área bajo la curva ROC (ABC-ROC). La calibración se estimó utilizando la razón de mortalidad y el estadístico de Hosmer-Lemeshow. Las cuatro escalas discriminaron entre supervivientes y no supervivientes con áreas bajo la curva >0.85. El modelo APACHE II-M fue el modelo pronóstico con mayor discriminación y calibración. En la regresión de Hosmer-Lemeshow la predicción de mortalidad de APACHE II y O-SOFA fue significativamente diferente a las muertes observadas.

Conclusiones

el APACHE II-M tuvo la mayor validez pronóstica para predecir muerte materna. Esta diferencia está dada por su mejoría en la calibración.

Palabras clave:
Escalas pronósticas
Mortalidad materna
Morbilidad materna severa
Morbilidad materna extrema
Unidad de cuidados intensivos

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