Sequential Organ Failure Assessment Score for Evaluating Organ Failure and Outcome of Severe Maternal Morbidity in Obstetric Intensive Care

Antonio Oliveira-Neto,Jose G Cecatti,Joao P Souza,Maria H Sousa,Mary A Parpinelli

doi:10.1100/2012/172145

Abstract

Objective. To evaluate the performance of Sequential Organ Failure Assessment (SOFA) score in cases of severe maternal morbidity (SMM). Design. Retrospective study of diagnostic validation. Setting. An obstetric intensive care unit (ICU) in Brazil. Population. 673 women with SMM. Main Outcome Measures. mortality and SOFA score. Methods. Organ failure was evaluated according to maximum score for each one of its six components. The total maximum SOFA score was calculated using the poorest result of each component, reflecting the maximum degree of alteration in systemic organ function. Results. highest total maximum SOFA score was associated with mortality, 12.06 ± 5.47 for women who died and 1.87 ± 2.56 for survivors. There was also a significant correlation between the number of failing organs and maternal mortality, ranging from 0.2% (no failure) to 85.7% (≥3 organs). Analysis of the area under the receiver operating characteristic (ROC) curve (AUC) confirmed the excellent performance of total maximum SOFA score for cases of SMM (AUC = 0.958). Conclusions. Total maximum SOFA score proved to be an effective tool for evaluating severity and estimating prognosis in cases of SMM. Maximum SOFA score may be used to conceptually define and stratify the degree of severity in cases of SMM.

Highlights

Severe complications are estimated to occur in15% of pregnancies, resulting in 529.000 maternal deaths annually worldwide [1]
Studies that have evaluated severe maternal morbidity (SMM) in intensive care units (ICU) have reported that the degree of organ dysfunction, the number of failing organs, and the duration of the condition were variables directly related to higher maternal mortality [8, 9, 12,13,14]
A logistic regression model was adjusted according to the outcome of admission to the ICU considering total maximum Sequential Organ Failure Assessment (SOFA) score as the only independent variable, and the estimated probability of death was calculated for each case

Summary

Introduction

Severe complications are estimated to occur in15% of pregnancies, resulting in 529.000 maternal deaths annually worldwide [1]. Maternal deaths arise from the risk attributable to pregnancy as well as from the poor-quality care from health services [2]. Maternal death should be understood as the final stage of an ongoing condition of severe maternal morbidity (SMM). Organ dysfunction is a continuous, dynamic process of alterations in organ function [6, 7] and is part of the pathophysiologic process of SMM [7,8,9,10]. Studies that have evaluated SMM in intensive care units (ICU) have reported that the degree of organ dysfunction, the number of failing organs, and the duration of the condition were variables directly related to higher maternal mortality [8, 9, 12,13,14]

Methods

Results

Discussion

Conclusion