Comparación de 4 escalas pronósticas para predecir mortalidad en pacientes con morbilidad materna severa / Comparison of four prognostic scales for predicting mortality in patients with severe maternal morbidity

Objetivo Comparar la validez pronóstica del APACHE II-M y O-SOFA versus el APACHE II y SOFA para predecir mortalidad en pacientes con morbilidad materna severa. Diseño Estudio de cohorte, retrospectivo, longitudinal y analítico. Ámbito Unidad de cuidados intensivos (UCI) médico-quirúrgica de un hospital de tercer nivel. Pacientes Pacientes embarazadas o puérperas de cualquier edad ingresadas en la UCI. Intervenciones Cálculo de scores pronósticos al ingreso. Variables de interés APACHE II, SOFA, APACHE II-M, O-SOFA y mortalidad materna. Resultados Se incluyeron 141 pacientes. Noventa y nueve (70,2%) fueron puérperas. El diagnóstico más frecuente fue la enfermedad hipertensiva del embarazo (50 casos). La discriminación de cada modelo pronóstico se estimó con el área bajo la curva ROC (ABC-ROC). La calibración se estimó utilizando la razón de mortalidad y el estadístico de Hosmer-Lemeshow. Las 4 escalas discriminaron entre supervivientes y no supervivientes con áreas bajo la curva >0,85. El modelo APACHE II-M fue el modelo pronóstico con mayor discriminación y calibración. En la regresión de Hosmer-Lemeshow la predicción de mortalidad de APACHE II y O-SOFA fue significativamente diferente a las muertes observadas. Conclusiones el APACHE II-M tuvo la mayor validez pronóstica para predecir muerte materna. Esta diferencia está dada por su mejoría en la calibración. (AU)

Objective To compare the prognostic validity of the APACHE II-M and O-SOFA scales versus the APACHE II and SOFA to predict mortality in patients with severe maternal morbidity. Design A retrospective, longitudinal and analytical cohort study was carried out. Setting Medical-surgical intensive care unit (ICU) of a tertiary hospital. Patients Pregnant or puerperal patients of any age admitted to the ICU. Interventions Calculation of prognostic scores upon admission. Variables of interest APACHE II, SOFA, APACHE II-M and O-SOFA scores and maternal mortality. Results A total of 141 patients were included. The majority (70.2%) were puerperal. The most frequent diagnosis was gestational hypertensive disease (50 cases). The discrimination of each prognostic model was estimated with the area under the ROC curve (AUC-ROC). The calibration was estimated using the mortality ratio and the Hosmer-Lemeshow statistic. The four scales discriminated between survivors and non-survivors with areas under the curve >0.85. The APACHE II-M model was the predictive model with the highest discrimination and calibration. In the Hosmer-Lemeshow regression analysis, mortality as predicted by the APACHE II and O-SOFA was significantly different from the observed mortality. Conclusions The APACHE II-M exhibited the greatest prognostic validity in predicting maternal mortality. This difference was given by its improvement in calibration. (AU)

Comparison of four prognostic scales for predicting mortality in patients with severe maternal morbidity. / Comparación de 4 escalas pronósticas para predecir mortalidad en pacientes con morbilidad materna severa.

OBJECTIVE: To compare the prognostic validity of the APACHE II-M and O-SOFA scales versus the APACHE II and SOFA to predict mortality in patients with severe maternal morbidity. DESIGN: A retrospective, longitudinal and analytical cohort study was carried out. SETTING: Medical-surgical intensive care unit (ICU) of a tertiary hospital. PATIENTS: Pregnant or puerperal patients of any age admitted to the ICU. INTERVENTIONS: Calculation of prognostic scores upon admission. VARIABLES OF INTEREST: APACHE II, SOFA, APACHE II-M and O-SOFA scores and maternal mortality. RESULTS: A total of 141 patients were included. The majority (70.2%) were puerperal. The most frequent diagnosis was gestational hypertensive disease (50 cases). The discrimination of each prognostic model was estimated with the area under the ROC curve (AUC-ROC). The calibration was estimated using the mortality ratio and the Hosmer-Lemeshow statistic. The four scales discriminated between survivors and non-survivors with areas under the curve >0.85. The APACHE II-M model was the predictive model with the highest discrimination and calibration. In the Hosmer-Lemeshow regression analysis, mortality as predicted by the APACHE II and O-SOFA was significantly different from the observed mortality. CONCLUSIONS: The APACHE II-M exhibited the greatest prognostic validity in predicting maternal mortality. This difference was given by its improvement in calibration.