产科合并症指数（OB-CMI）及其与肺动脉高压孕妇入住重症监护病房和住院时间的关联：一项回顾性队列研究（1996 - 2025年）
The Obstetric Comorbidity Index (OB-CMI) and its association with ICU admission and length of hospital stay in pregnant patients with pulmonary hypertension: a retrospective cohort study (1996-2025).
作者信息
Ahmed S, Liu E, Eberhard B, Villela-Franyutti D, Gray K, Drzymalski D, Kovacheva V
机构信息
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Department of Anesthesiology and Perioperative Medicine, Tufts Medicine, Boston, MA, USA.
出版信息
Int J Obstet Anesth. 2025 Aug 9;64:104751. doi: 10.1016/j.ijoa.2025.104751.
BACKGROUND
Pulmonary hypertension in pregnancy is associated with adverse pregnancy outcomes, such as prolonged hospitalization, intensive care unit (ICU) admission, and high maternal mortality. The Obstetric Comorbidity Index (OB-CMI) assesses maternal risk for these outcomes; however, its predictive power in patients with pulmonary hypertension remains unknown. This study evaluates maternal and neonatal outcomes in patients with pulmonary hypertension and examines whether a higher comorbidity burden is associated with longer hospitalization and ICU admission.
METHODS
A retrospective cohort study was conducted using electronic health records from Mass General Brigham and Tufts Medical Center (1996-July 2025). Patients with pulmonary hypertension and pregnancies beyond 20 weeks' gestation were identified using the International Classification of Disease-9/10 codes. Data were collected via manual chart review, and descriptive statistics and univariate regression analyses were performed (P < 0.05).
RESULTS
Sixty-five pregnancies among 61 patients were identified. The median maternal age was 32.9 (interquartile range 28.9-36.6) years. The maternal mortality rate was 3 %, with both deaths occurring before 2000. Most patients (56.9 %) had cesarean delivery under epidural anesthesia (69.2 %). Median OB-CMI was 9, and median hospitalization was 6 days. Pulmonary artery pressure was associated with prolonged hospitalization (P = 0.004) and ICU admission (P = 0.027). OB-CMI showed borderline association with ICU admission (P = 0.046), but not hospitalization duration (P = 0.580).
CONCLUSIONS
In patients with pulmonary hypertension, ICU admission and prolonged hospitalization were common and associated with pulmonary arterial pressure but not OB-CMI. Further studies are needed to develop scoring tools specific to pulmonary hypertension patients to improve risk assessment.
背景
妊娠期肺动脉高压与不良妊娠结局相关，如住院时间延长、入住重症监护病房（ICU）以及孕产妇高死亡率。产科合并症指数（OB-CMI）可评估孕产妇出现这些结局的风险；然而，其在肺动脉高压患者中的预测能力尚不清楚。本研究评估了肺动脉高压患者的孕产妇和新生儿结局，并探讨合并症负担较重是否与住院时间延长和入住ICU相关。
方法
利用麻省总医院布莱根分院和塔夫茨医疗中心（1996年至2025年7月）的电子健康记录进行了一项回顾性队列研究。使用国际疾病分类第9/10版编码确定患有肺动脉高压且妊娠超过20周的患者。通过人工查阅病历收集数据，并进行描述性统计和单因素回归分析（P < 0.05）。
结果
共确定了61例患者的65次妊娠。孕产妇年龄中位数为32.9岁（四分位间距28.9 - 36.6岁）。孕产妇死亡率为3%，两例死亡均发生在2000年之前。大多数患者（56.9%）在硬膜外麻醉下剖宫产（69.2%）。OB-CMI中位数为9，住院时间中位数为6天。肺动脉压与住院时间延长（P = 0.004）和入住ICU相关（P = 0.027）。OB-CMI与入住ICU呈临界关联（P = 0.046），但与住院时长无关（P = 0.580）。
结论
在肺动脉高压患者中，入住ICU和住院时间延长很常见，且与肺动脉压相关，但与OB-CMI无关。需要进一步研究开发针对肺动脉高压患者的评分工具，以改善风险评估。
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