Aarvold Alice B R, Ryan Helen M, Magee Laura A, von Dadelszen Peter, Fjell Chris, Walley Keith R
1Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada. 2Wessex School of Anesthesia, Wessex Deanery, Southern House, Otterbourne, Winchester, England. 3Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada. 4CFRI Reproduction and Healthy Pregnancy Cluster, Vancouver, BC, Canada. 5Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Crit Care Med. 2017 Jan;45(1):e49-e57. doi: 10.1097/CCM.0000000000002018.
Mortality prediction scores have been used for a long time in ICUs; however, numerous studies have shown that they over-predict mortality in the obstetric population. With sepsis remaining a major cause of obstetric mortality, we aimed to look at five mortality prediction scores (one obstetric-based and four general) in the septic obstetric population and compare them to a nonobstetric septic control group.
Women in the age group of 16-50 years with an admission diagnosis or suspicion of sepsis were included. In a multicenter obstetric population (n = 797), these included all pregnant and postpartum patients up to 6 weeks postpartum. An age- and gender-matched control nonobstetric population was drawn from a single-center general critical care population (n = 2,461). Sepsis in Obstetric Score, Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II, Sequential Organ Failure Assessment, and Multiple Organ Dysfunction Scores were all applied to patients meeting inclusion criteria in both cohorts, and their area under the receiver-operator characteristic curves was calculated to find the most accurate predictor.
A total of 146 septic patients were found for the obstetric cohort and 299 patients for the nonobstetric control cohort. The Sepsis in Obstetric Score, Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II, Sequential Organ Failure Assessment, and Multiple Organ Dysfunction Scores gave area under the receiver-operator characteristic curves of 0.67, 0.68, 0.72, 0.79, and 0.84 in the obstetric cohort, respectively, and 0.64, 0.72, 0.61, 0.78, and 0.74 in the nonobstetric cohort, respectively. The Sepsis in Obstetric Score performed similarly to all the other scores with the exception of the Multiple Organ Dysfunction Score, which was significantly better (p < 0.05).
The Sepsis in Obstetric Score, designed specifically for sepsis in obstetric populations, was not better than general severity of illness scoring systems. Furthermore, the Sepsis in Obstetric Score performance was no different in an obstetric sepsis population compared to a nonobstetric sepsis population. The Multiple Organ Dysfunction Score is a simple organ-based score, and this result supports the use of organ-based outcome predictors in ICU even in an obstetric sepsis population.
死亡率预测评分在重症监护病房（ICU）已使用很长时间；然而，大量研究表明，它们对产科人群的死亡率预测过高。由于脓毒症仍是产科死亡的主要原因，我们旨在研究脓毒症产科人群中的五种死亡率预测评分（一种基于产科，四种通用评分），并将其与非产科脓毒症对照组进行比较。
纳入年龄在16 - 50岁、入院诊断或疑似脓毒症的女性。在一个多中心产科人群（n = 797）中，这些包括所有孕期及产后6周内的孕妇和产后患者。从单中心综合重症监护人群中选取年龄和性别匹配的非产科对照人群（n = 2461）。产科脓毒症评分、急性生理与慢性健康状况评价Ⅱ（APACHE II）、简化急性生理学评分Ⅱ（SAPS II）、序贯器官衰竭评估（SOFA）和多器官功能障碍评分均应用于两个队列中符合纳入标准的患者，并计算其受试者工作特征曲线下面积，以找出最准确的预测指标。
产科队列共发现146例脓毒症患者，非产科对照队列共299例患者。产科脓毒症评分、APACHE II、SAPS II、SOFA和多器官功能障碍评分在产科队列中的受试者工作特征曲线下面积分别为0.67、0.68、0.72、0.79和0.84，在非产科队列中分别为0.64、0.72、0.61、0.78和0.74。产科脓毒症评分的表现与所有其他评分相似，但多器官功能障碍评分除外，其表现明显更好（p < 0.05）。
专门为产科人群脓毒症设计的产科脓毒症评分并不优于一般疾病严重程度评分系统。此外，产科脓毒症人群中产科脓毒症评分的表现与非产科脓毒症人群并无差异。多器官功能障碍评分是一种基于简单器官的评分，这一结果支持在ICU中使用基于器官的预后预测指标，即使是在产科脓毒症人群中。
