Comparison of the CIPHER prognostic model with the existing scores in predicting severe maternal outcomes during intensive care unit admission.

OBJECTIVE: To compare the performance of the Collaborative Integrated Pregnancy High-Dependency Estimate of Risk (CIPHER) model in predicting maternal death and near-miss morbidity (Severe Maternal Outcome [SMO]) with the Sequential Organ Failure Assessment (SOFA), the Acute Physiology and Chronic Health Evaluation (APACHE) II, and the Simplified Acute Physiology Score (SAPS) III scores. METHODS: A retrospective and a prospective study was conducted at two centers in Brazil. For each score, area under curve (AUC) was used and score calibration was assessed using the Hosmer-Lemeshow statistic (H-L) test and the standardized mortality ratio (SMR). RESULTS: A cohort of 590 women was analyzed. A SMO was observed in 216 (36.6%) women. Of these, 13 (2.2%) were maternal deaths and 203 (34.4%) met one or more maternal near-miss criteria. The CIPHER model did not show significant diagnostic ability (AUC 0.52) and consequently its calibration was poor (H-L P < 0.05). The SAPS III had the best performance (AUC 0.77, H-L P > 0.05 and SMR 0.85). CONCLUSION: The performance of the CIPHER model was lower compared to the other scores. Since the CIPHER model is not ready for clinical use, the SAPS III score should be considered for the prediction of SMO.

Prognostic Value of an Estimate-of-Risk Model in Critically Ill Obstetric Patients in Brazil.

OBJECTIVE: To externally validate the CIPHER (Collaborative Integrated Pregnancy High-Dependency Estimate of Risk) prognostic model for pregnant and postpartum women admitted to the intensive care unit. METHODS: A retrospective and a prospective validation study were conducted at two reference centers in Brazil. A composite outcome was defined as maternal death or need for prolonged organ support (more than 7 days) or acute lifesaving intervention. To evaluate the performance of the CIPHER model, a receiver operating characteristic curve was used and score calibration was assessed by the Hosmer-Lemeshow test. We conducted a descriptive analysis comparing the results of the current study with the results of the model development study. RESULTS: A total of 590 women were included. The composite outcome was observed in 90 (15.2%) women. Of these, 13 (2.2%) were maternal deaths and 77 (13%) required one or more component of organ support or lifesaving intervention. The CIPHER model's area under the curve (AOC) did not show significant predictive ability (AOC 0.53, 95% CI 0.46-0.60), and consequently its calibration was poor (Hosmer-Lemeshow test P<.05). CONCLUSION: The CIPHER model for prediction of mortality and need for interventions in critically ill obstetric patients did not perform well in our Brazilian population. Different predictors of morbidity and mortality may need to be used for patients receiving care in public hospitals in low- and middle-income countries.

CD89 Is a Potent Innate Receptor for Bacteria and Mediates Host Protection from Sepsis.

Direct bacterial recognition by innate receptors is crucial for bacterial clearance. Here, we show that the IgA receptor CD89 is a major innate receptor that directly binds bacteria independently of its cognate ligands IgA and c-reactive protein (CRP). This binding is only partially inhibited by serum IgA and induces bacterial phagocytosis by CD11c+ dendritic cells and monocytes and/or macrophages, suggesting a physiological role in innate host defense. Blood phagocytes from common variable immunodeficiency patients bind, internalize, and kill bacteria in a CD89-dependent manner, confirming the IgA independence of this mechanism. In vivo, CD89 transgenic mice are protected in two different models of sepsis: a model of pneumonia and the cecal ligation and puncture (CLP) polymicrobial model of infection. These data identify CD89 as a first-line innate receptor for bacterial clearance before adaptive responses can be mounted. Fc receptors may emerge as a class of innate receptors for various bacteria with pleiotropic roles.