765 Are qSOFA and omSOFA predictive of maternal adverse outcomes?

Abstract

The Quick Sequential Organ Failure Assessment (qSOFA) is a tool intended to identify patients with infection at risk of adverse outcomes. The Obstetrically Modified SOFA (omSOFA) is a modified version proposed by The Society of Obstetric Medicine Australia and New Zealand. We sought to determine if qSOFA and omSOFA are applicable to our obstetric population. A retrospective cohort study was conducted of pregnant patients with infection at a single tertiary center from October 1, 2015 to August 31, 2020. Patients were categorized as those with or without maternal adverse outcomes (MAO). MAO comprises one or more of the following: intensive care unit admission, procedure due to infection, hypotension requiring vasopressors or steroids, liver dysfunction, respiratory distress syndrome, pulmonary edema, high flow nasal cannula or mechanical ventilation, disseminated intravascular coagulation, altered mental status, ileus, dialysis, organ failure, venous thromboembolism, or maternal death. Continous data was analyzed with Wilcoxon Rank-Sum Test. Categorical variables were analyzed using Fisher’s Exact Test. Sensitivity and specificity was calculated for detection of MAO by qSOFA and omSOFA. 98 patients met inclusion criteria. 43 (43.9%) had MAO and 55 (56.1%) did not have MAO. Only 4.1% (4/98) of all patients had altered mental status, representing 9.3% (4/43) of those with MAO. Maximal respiratory rate was 26.4 (SD 11.6) for all patients and 31.2 (SD 14.5) for those with MAO. Minimal systolic blood pressure was 93.3 (SD 15.1) for the total population and 92.9 (SD 13.6) for those with MAO. The sensitivity and specificity of qSOFA for MAO was 51.2% and 85.5%, respectively. While the specificity of omSOFA for MAO was 98.2%, the sensitivity was 27.9%. Although reasonably specific for maternal adverse outcomes due to infection, qSOFA and omSOFA lack sensitivity for detection in our population. Studies with larger power are needed to further validate these findings.View Large Image Figure ViewerDownload Hi-res image Download (PPT)