Critically ill obstetric patients: outcome and predictability

Introduction

Outcome prediction in the critically ill obstetric patient is controversial.

Objective

To determine the applicability of SAPS II, APACHE II and APACHE III-J scores calculated at day 1 of admission in outcome prediction.

Design

An open prospective data collection, as part of the Assessment of Prognosis and Risk of Mortality in Obstetrics (APRiMO) study. Discrimination was assessed by area under the receiver operator characteristic curve (AUROC). Calibration was assessed by Hosmer–Lemeshow (HL) C statistic. P < 0.05 was considered significant.

Setting

A multidisciplinary ICU.

Study period

January 1996–December 2003.

Patients

Obstetric patients (n = 541) admitted for at least 4 hours in the ICU.

Measurements and results

Mean age was 31.2 ± 5.9, mean term was 34.7 ± 4.5 weeks. Seventy percent of admissions were obstetric complications. The mortality rate was 10.4% (n = 57). The three scores discriminated (Fig. 1) and calibrated (Table 1) well. APACHE III was the only score to calibrate well using original mortality prediction equations (Table 2).

Table 1

Table 2

Figure 1

Receiver operator characteristic curves of the severity scoring systems' admissions.

Conclusion

The three scores are good discriminators. Customization of the mortality prediction equations seems necessary. APACHE III-J seems to be the best (adjustment by adequate diagnostic categories).