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Evaluation of standard and modified severity of illness scores in the obstetric patient.
MedLine Citation:
PMID:  21106337     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
PURPOSE: To test discrimination and calibration of APACHE-II and SAPS-II risk prediction scores in a cohort of obstetric patients, and to evaluate the effect of modifying these scores for the physiological changes in pregnancy.
MATERIALS AND METHODS: A retrospective review of obstetric patients, 12 weeks gestation to 48 hours postpartum, admitted to the ICU for more than 24 hours. APACHE-II and SAPS-II, and versions modified for the physiological changes of pregnancy, were evaluated by receiver operating characteristic (ROC) curves and standardized mortality ratios (SMR). Multivariable analysis identified other parameters associated with mortality.
RESULTS: Data were obtained from 332 patients from 5 countries, with a mortality rate of 12%. Mean (± SD) APACHE-II score was 16.8 ± 6.1 and SAPS-II score 26.5 ± 15.8. Good discrimination was demonstrated with area under the ROC curves of 0.82 and 0.78 respectively, with no improvement after modification for altered maternal physiology. APACHE-II overestimated mortality, with an SMR of 0.43 (0.52 after including diagnostic weighting) compared with 0.89 for SAPS-II. Bilirubin, albumin and Glasgow Coma Scale were independently associated with mortality.
CONCLUSION: APACHE-II and SAPS-II are good discriminators of illness severity and may be valuable for comparing obstetric cohorts, but APACHE-II significantly over-estimates mortality.
Authors:
Stephen E Lapinsky; David Hallett; Nancy Collop; John Drover; Peter Lavercombe; Marc Leeman; Shiraz Moola; Fathima Paruk; Michael Bernstein; Jack Moodley
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Publication Detail:
Type:  Journal Article     Date:  2010-11-23
Journal Detail:
Title:  Journal of critical care     Volume:  26     ISSN:  1557-8615     ISO Abbreviation:  J Crit Care     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-04     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8610642     Medline TA:  J Crit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  535.e1-7     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
Intensive Care Unit, Mount Sinai Hospital and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada M5G 1X5.
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