Critically ill obstetrical patients

Lewinsohn, G; Herman, Arie; Leonov, Yuval; Klinowski, Elieser

doi:10.1097/00003246-199409000-00010

Cited by 82 publications

(25 citation statements)

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“…In previous studies, most risk prediction scores tended to overestimate mortality in obstetric pathologies [1-4,30,31]. This is likely to be, in part, due to the self-limiting nature of pre-eclampsia and haemorrhage (responsible for the majority of cases) if supportive management is provided.…”

Section: Discussionmentioning

confidence: 96%

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Case mix, outcome and activity for obstetric admissions to adult, general critical care units: a secondary analysis of the ICNARC Case Mix Programme Database

et al. 2005

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IntroductionRisk prediction scores usually overestimate mortality in obstetric populations because mortality rates in this group are considerably lower than in others. Studies examining this effect were generally small and did not distinguish between obstetric and nonobstetric pathologies. We evaluated the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II model in obstetric admissions to critical care units contributing to the ICNARC Case Mix Programme.MethodsAll obstetric admissions were extracted from the ICNARC Case Mix Programme Database of 219,468 admissions to UK critical care units from 1995 to 2003 inclusive. Cases were divided into direct obstetric pathologies and indirect or coincidental pathologies, and compared with a control cohort of all women aged 16–50 years not included in the obstetric categories. The predictive ability of APACHE II was evaluated in the three groups. A prognostic model was developed for direct obstetric admissions to predict the risk for hospital mortality. A log-linear model was developed to predict the length of stay in the critical care unit.ResultsA total of 1452 direct obstetric admissions were identified, the most common pathologies being haemorrhage and hypertensive disorders of pregnancy. There were 278 admissions identified as indirect or coincidental and 22,938 in the nonpregnant control cohort. Hospital mortality rates were 2.2%, 6.0% and 19.6% for the direct obstetric group, the indirect or coincidental group, and the control cohort, respectively. Cox regression calibration analysis showed a reasonable fit of the APACHE II model for the nonpregnant control cohort (slope = 1.1, intercept = -0.1). However, the APACHE II model vastly overestimated mortality for obstetric admissions (mortality ratio = 0.25). Risk prediction modelling demonstrated that the Glasgow Coma Scale score was the best discriminator between survival and death in obstetric admissions.ConclusionThis study confirms that APACHE II overestimates mortality in obstetric admissions to critical care units. This may be because of the physiological changes in pregnancy or the unique scoring profile of obstetric pathologies such as HELLP syndrome. It may be possible to recalibrate the APACHE II score for obstetric admissions or to devise an alternative score specifically for obstetric admissions.

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Section: Discussionmentioning

confidence: 96%

“…Several scores have been evaluated in obstetric patients in general ICUs and found to overestimate [1-4], underestimate [5] and accurately predict [6,7] mortality. These surveys were relatively small and retrospective and therefore may not have identified all suitable cases.…”

Section: Introductionmentioning

confidence: 99%

Case mix, outcome and activity for obstetric admissions to adult, general critical care units: a secondary analysis of the ICNARC Case Mix Programme Database

et al. 2005

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“…However, these scoring systems have important limitations, such as inaccuracy according to the type of disease [31–33], lead time bias [34], and need for updating [35]. The accuracy of prediction of mortality with severity scoring indices alone is relatively poor.…”

Section: Discussionmentioning

confidence: 99%

Delta neutrophil index is an independent predictor of mortality in septic acute kidney injury patients treated with continuous renal replacement therapy

et al. 2017

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BackgroundDelta neutrophil index (DNI), representing an elevated fraction of circulating immature granulocytes in acute infection, has been reported as a useful marker for predicting mortality in patients with sepsis. The aim of this study was to evaluate the prognostic value of DNI in predicting mortality in septic acute kidney injury (S-AKI) patients treated with continuous renal replacement therapy (CRRT).MethodThis is a retrospective analysis of consecutively CRRT treated patients. We enrolled 286 S-AKI patients who underwent CRRT and divided them into three groups based on the tertiles of DNI at CRRT initiation (high, DNI > 12.0%; intermediate, 3.6–12.0%; low, < 3.6%). Patient survival was estimated with the Kaplan-Meier method and Cox proportional hazards models to determine the effect of DNI on the mortality of S-AKI patients.ResultsPatients in the highest tertile of DNI showed higher Acute Physiology and Chronic Health Evaluation II score (highest tertile, 27.9 ± 7.0; lowest tertile, 24.6 ± 8.3; P = 0.003) and Sequential Organ Failure Assessment score (highest tertile, 14.1 ± 3.0; lowest tertile, 12.1 ± 4.0; P = 0.001). The 28-day mortality rate was significantly higher in the highest tertile group than in the lower two tertile groups (P < 0.001). In the multiple Cox proportional hazard model, DNI was an independent predictor for mortality after adjusting multiple confounding factors (hazard ratio, 1.010; 95% confidence interval, 1.001–1.019; P = 0.036).ConclusionThis study suggests that DNI is independently associated with mortality of S-AKI patients on CRRT.

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“…The predictors of outcomes in pregnant women showed that PT, total bilirubin, and APACHE scores increased the risk of maternal death in perinatal period. Previous studies examining the predictive value of critical care scoring systems such as APACHE or the simplified acute physiologic score in critically ill pregnant women have yielded conflicting data, which makes the applicability of these scores in pregnant patients controversial [9,[18][19][20]. Hazelgrove et al [21] showed that the predicted mortality of simplified acute physiologic score, and APACHE II and III scores in 210 obstetric ICU patients overestimated the actual mortality.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Risk Factors Affecting the Outcome of Critically Ill Pregnant and Postpartum Women

Pan¹,

Sun²,

Gong³

et al. 2017

Chemotherapy

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The mortality of critically ill pregnant women is an important global health concern. Therefore, we evaluated the risk factors affecting the mortality of critically ill pregnant women admitted to the intensive care unit. All critically ill pregnant patients >18 year from the second affiliated hospital of Wenzhou Medical University. Finally, a total of 100 adult pregnant women were admitted to the intensive care unit. 69 pregnant women were survivor (28.29 ± 4.70 year) with gestational age of 33.33 ± 6.13 week; while 31 pregnant women non-survivor (29.50 ± 5.37 year) with gestational age of 33.21 ± 3.44 week. Multivariable logistic regression analysis showed that PT(OR:6.409; 95% CI, 1.855-22.140; p=0.003), total bilirubin (OR:3.125; 95% CI, 1.013-9.644; p=0.037) and APACHE III score (OR:4.750; 95% CI, 1.488-15.167; p=0.009) were associated with maternal mortality. Considering these promising results, PT, total bilirubin and APACHE III score significantly affect the outcomes of pregnant women admitted to the ICU. Critically ill pregnant patients with liver problems should be carefully monitored.

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Critically ill obstetrical patients

Cited by 82 publications

References 3 publications

Case mix, outcome and activity for obstetric admissions to adult, general critical care units: a secondary analysis of the ICNARC Case Mix Programme Database

Case mix, outcome and activity for obstetric admissions to adult, general critical care units: a secondary analysis of the ICNARC Case Mix Programme Database

Delta neutrophil index is an independent predictor of mortality in septic acute kidney injury patients treated with continuous renal replacement therapy

Analysis of Risk Factors Affecting the Outcome of Critically Ill Pregnant and Postpartum Women

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