1117 Do severity scoring systems for sepsis predict obstetric and neonatal outcomes?

Abstract

Sepsis severity scores are frequently used in the emergency setting to predict intensive care unit (ICU) admission and mortality. However, these tools have not been well validated in obstetric populations and little is known about whether they predict obstetric and neonatal complications. This is a retrospective cohort study of patients who delivered at our institution from 8/1/2012 to 8/1/2018 and had an antepartum hospitalization for sepsis. Vital sign data, laboratory data, and patient’s mental status were extracted from the electronic medical record and the single worst composite recording was used to derive Sepsis in Obstetric Score (SOS), Sequential Organ Failure Assessment (qSOFA), Modified Early Warning Score (MEWS), and National Early Warning Score (NEWS) for each patient. Area under the receiver-operator characteristic (ROC) curves were generated to assess each scoring system’s prognostic performance for ICU admission, delivery within 7 days of sepsis admission, a composite of perinatal complications, and preterm birth less than 34 weeks. 70 of 15,055 patients (0.5%) had an antepartum admission for sepsis. The most common infection types were pulmonary (39%) and renal infections (39%). Fourteen percent were admitted to the ICU, overall mortality was 1.4%, and 16% delivered during their sepsis hospitalization. Areas under the ROC curves were calculated for SOS, qSOFA, MEWS, and NEWS, respectively, to predict the following outcomes: Antepartum ICU Admission – 0.90, 0.92, 0.89, and 0.87 (p = 0.63); Delivery < 7 days of sepsis admission – 0.75, 0.62, 0.74, and 0.83 (p = 0.10); Perinatal complication – 0.68, 0.55, 0.61, and 0.64 (p = 0.18); Preterm birth < 34 weeks – 0.62, 0.75, 0.65, and 0.63 (p = 0.35). In our obstetric population with sepsis, qSOFA was the best predictor of ICU admission and preterm birth < 34 weeks. NEWS was the best predictor of delivery within 7 days of sepsis hospitalization. All scoring systems were poor predictors of perinatal complications. Use of qSOFA and NEWS may aid in delivery planning for patients with sepsis in pregnancy.