Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
Intensive Care Unit, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Canada.
BMC Pregnancy Childbirth. 2017 Nov 13;17(1):372. doi: 10.1186/s12884-017-1558-3.
Maternal critical illness occurs in 1.2 to 4.7 of every 1000 live births in the United States and approximately 1 in 100 women who become critically ill will die. Patient characteristics and comorbid conditions are commonly summarized as an index or score for the purpose of predicting the likelihood of dying; however, most such indices have arisen from non-pregnant patient populations. We sought to systematically review comorbidity indices used in health administrative datasets of pregnant women, in order to critically appraise their measurement properties and recommend optimal tools for clinicians and maternal health researchers.
We conducted a systematic search of MEDLINE and EMBASE to identify studies published from 1946 and 1947, respectively, to May 2017 that describe predictive validity of comorbidity indices using health administrative datasets in the field of maternal health research. We applied a methodological PubMed search filter to identify all studies of measurement properties for each index.
Our initial search retrieved 8944 citations. The full text of 61 articles were identified and assessed for final eligibility. Finally, two eligible articles, describing three comorbidity indices appropriate for health administrative data remained: The Maternal comorbidity index, the Charlson comorbidity index and the Elixhauser Comorbidity Index. These studies of identified indices had a low risk of bias. The lack of an established consensus-building methodology in generating each index resulted in marginal sensibility for all indices. Only the Maternal Comorbidity Index was derived and validated specifically from a cohort of pregnant and postpartum women, using an administrative dataset, and had an associated c-statistic of 0.675 (95% Confidence Interval 0.647-0.666) in predicting mortality.
Only the Maternal Comorbidity Index directly evaluated measurement properties relevant to pregnant women in health administrative datasets; however, it has only modest predictive ability for mortality among development and validation studies. Further research to investigate the feasibility of applying this index in clinical research, and its reliability across a variety of health administrative datasets would be incrementally helpful. Evolution of this and other tools for risk prediction and risk adjustment in pregnant and post-partum patients is an important area for ongoing study.
在美国，每 1000 例活产中就有 1.2 到 4.7 例产妇发生危急重症，而大约每 100 位重症产妇中就有 1 位会死亡。患者特征和合并症通常被总结为一个指数或评分，用于预测死亡的可能性；然而，大多数此类指数都是基于非妊娠患者人群得出的。我们旨在系统性地综述妊娠患者健康管理数据集所使用的合并症指数，以便批判性地评估其测量性能，并为临床医生和孕产妇健康研究人员推荐最佳工具。
我们系统性检索了 MEDLINE 和 EMBASE，分别检索到了自 1946 年和 1947 年发表的文献，截至 2017 年 5 月，这些文献描述了使用孕产妇健康研究领域健康管理数据集的合并症指数的预测有效性。我们应用了一种方法学的 PubMed 搜索过滤器，以识别每个指数的所有测量性能研究。
我们最初的搜索共检索到 8944 条引文。确定了 61 篇全文文章，并对其进行了最终资格评估。最终，有两篇符合条件的文章，描述了适用于健康管理数据的三个合并症指数：产妇合并症指数、Charlson 合并症指数和 Elixhauser 合并症指数。这些已确定指数的研究具有较低的偏倚风险。由于在生成每个指数时缺乏既定的共识建立方法，导致所有指数的敏感性都较低。只有产妇合并症指数是专门从一组妊娠和产后妇女的管理数据集衍生和验证而来的，其在预测死亡率方面的 C 统计量为 0.675（95%置信区间 0.647-0.666）。
只有产妇合并症指数直接评估了与健康管理数据集中妊娠妇女相关的测量性能；然而，在开发和验证研究中，它对死亡率的预测能力也只有中等程度。进一步研究探索将该指数应用于临床研究的可行性及其在各种健康管理数据集之间的可靠性将具有增量价值。在孕妇和产后患者中进行风险预测和风险调整的此类工具的发展是一个持续研究的重要领域。
