Stephen E Lapinsky1, David Hallett2, Nancy Collop3, John Drover4, Peter Lavercombe5, Marc Leeman6, Shiraz Moola7, Fathima Paruk8, Michael Bernstein2, Jack Moodley9. 1. Intensive Care Unit, Mount Sinai Hospital and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada M5G 1X5. Electronic address: stephen.lapinsky@utoronto.ca. 2. Intensive Care Unit, Mount Sinai Hospital and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada M5G 1X5. 3. Division of Pulmonary/Critical Care Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA. 4. Critical Care Program, Queen's University and Kingston General Hospital, Kingston, ON K7L1V9, Canada. 5. Intensive Care Unit, St Andrew's War Memorial Hospital, Brisbane 4000, Australia. 6. Department of Intensive Care, Erasme University Hospital, Brussels 1070, Belgium. 7. Kootenay Lake Hospital, Nelson, BC V1L2V1, Canada. 8. Department Of Anaesthesiology, University of Witwatersrand, Johannesburg 2000, South Africa. 9. King Edward VIII Hospital and Womens Health and HIV Research group, University of Kwa Zulu Natal, Durban 4013, South Africa.
Abstract
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.
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: Samira Maerrawi Haddad; Jose Guilherme Cecatti; Joao Paulo Souza; Maria Helena Sousa; Mary Angela Parpinelli; Maria Laura Costa; Rodolfo C Pacagnella; Ione R Brum; Olímpio B Moraes Filho; Francisco E Feitosa; Carlos A Menezes; Everardo M Guanabara; Joaquim L Moreira; Frederico A Peret; Luiza E Schmaltz; Leila Katz; Antonio C Barbosa Lima; Melania M Amorim; Marilia G Martins; Denis J Nascimento; Cláudio S Paiva; Roger D Rohloff; Sergio M Costa; Adriana G Luz; Gustavo Lobato; Eduardo Cordioli; Jose C Peraçoli; Nelson L Maia Filho; Silvana M Quintana; Fátima A Lotufo; Carla B Andreucci; Márcia M Aquino; Rosiane Mattar Journal: Biomed Res Int Date: 2014-07-24 Impact factor: 3.411
Authors: Alex Farr; Agnes Lenz-Gebhart; Sabrina Einig; Clemens Ortner; Iris Holzer; Marie Elhenicky; Peter W Husslein; Rainer Lehner Journal: Wien Klin Wochenschr Date: 2017-01-18 Impact factor: 1.704
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Authors: Beth A Payne; Helen Ryan; Jeffrey Bone; Laura A Magee; Alice B Aarvold; J Mark Ansermino; Zulfiqar A Bhutta; Mary Bowen; J Guilherme Cecatti; Cynthia Chazotte; Tim Crozier; Anne-Cornélie J M de Pont; Oktay Demirkiran; Tao Duan; Marlot Kallen; Wessel Ganzevoort; Michael Geary; Dena Goffman; Jennifer A Hutcheon; K S Joseph; Stephen E Lapinsky; Isam Lataifeh; Jing Li; Sarka Liskonova; Emily M Hamel; Fionnuala M McAuliffe; Colm O'Herlihy; Ben W J Mol; P Gareth R Seaward; Ramzy Tadros; Turkan Togal; Rahat Qureshi; U Vivian Ukah; Daniela Vasquez; Euan Wallace; Paul Yong; Vivian Zhou; Keith R Walley; Peter von Dadelszen Journal: Crit Care Date: 2018-10-30 Impact factor: 9.097