Helen M Ryan1, Sumedha Sharma2, Laura A Magee3, J Mark Ansermino4, Karen MacDonell5, Beth A Payne2, Keith R Walley6, Peter von Dadelszen7. 1. Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Department of Family Practice, University of British Columbia, Vancouver BC; Child and Family Research Institute, University of British Columbia, Vancouver BC. 2. Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute, University of British Columbia, Vancouver BC. 3. Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute, University of British Columbia, Vancouver BC; Department of Medicine, University of British Columbia, Vancouver BC; Institute of Cardiovascular and Cell Sciences, St. George's, University of London, London, UK; Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, London, UK. 4. Child and Family Research Institute, University of British Columbia, Vancouver BC; Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver BC. 5. Library Services, College of Physicians and Surgeons of British Columbia, Vancouver BC. 6. Department of Medicine, University of British Columbia, Vancouver BC; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver BC. 7. Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute, University of British Columbia, Vancouver BC; Institute of Cardiovascular and Cell Sciences, St. George's, University of London, London, UK; Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, London, UK.
Abstract
OBJECTIVE: To assess the performance of the Acute Physiology and Chronic Health Evaluation II (APACHE II) mortality prediction model in pregnant and recently pregnant women receiving critical care in low-, middle-, and high-income countries during the study period (1985-2015), using a structured literature review. DATA SOURCES: Ovid MEDLINE, Embase, Web of Science, and Evidence-Based Medicine Reviews, searched for articles published between 1985 and 2015. STUDY SELECTION: Twenty-five studies (24 publications), of which two were prospective, were included in the analyses. Ten studies were from high-income countries (HICs), and 15 were from low- and middle-income countries (LMICs). Median study duration and size were six years and 124 women, respectively. DATA SYNTHESIS: ICU admission complicates 0.48% of deliveries, and pregnant and recently pregnant women account for 1.49% of ICU admissions. One quarter were admitted while pregnant, three quarters of these for an obstetric indication and for a median of three days. The median APACHE II score was 10.9, with a median APACHE II-predicted mortality of 16.6%. Observed mortality was 4.6%, and the median standardized mortality ratio was 0.36 (interquartile range 0.23 to 0.73). The standardized mortality ratio was < 0.9 in 24 of 25 studies. Women in HICs were more frequently admitted with a medical comorbidity but were less likely to die than were women in LMICs. CONCLUSION: The APACHE II score consistently overestimates mortality risks for pregnant and recently pregnant women receiving critical care, whether they reside in HICs or LMICs. There is a need for a pregnancy-specific outcome prediction model for these women.
OBJECTIVE: To assess the performance of the Acute Physiology and Chronic Health Evaluation II (APACHE II) mortality prediction model in pregnant and recently pregnant women receiving critical care in low-, middle-, and high-income countries during the study period (1985-2015), using a structured literature review. DATA SOURCES: Ovid MEDLINE, Embase, Web of Science, and Evidence-Based Medicine Reviews, searched for articles published between 1985 and 2015. STUDY SELECTION: Twenty-five studies (24 publications), of which two were prospective, were included in the analyses. Ten studies were from high-income countries (HICs), and 15 were from low- and middle-income countries (LMICs). Median study duration and size were six years and 124 women, respectively. DATA SYNTHESIS: ICU admission complicates 0.48% of deliveries, and pregnant and recently pregnant women account for 1.49% of ICU admissions. One quarter were admitted while pregnant, three quarters of these for an obstetric indication and for a median of three days. The median APACHE II score was 10.9, with a median APACHE II-predicted mortality of 16.6%. Observed mortality was 4.6%, and the median standardized mortality ratio was 0.36 (interquartile range 0.23 to 0.73). The standardized mortality ratio was < 0.9 in 24 of 25 studies. Women in HICs were more frequently admitted with a medical comorbidity but were less likely to die than were women in LMICs. CONCLUSION: The APACHE II score consistently overestimates mortality risks for pregnant and recently pregnant women receiving critical care, whether they reside in HICs or LMICs. There is a need for a pregnancy-specific outcome prediction model for these women.
Authors: Kazuyoshi Aoyama; Rohan D'Souza; Ruxandra Pinto; Joel G Ray; Andrea Hill; Damon C Scales; Stephen E Lapinsky; Gareth R Seaward; Michelle Hladunewich; Prakesh S Shah; Robert A Fowler Journal: PLoS One Date: 2018-12-04 Impact factor: 3.240
Authors: Karishma P Ramlakhan; Diederik Gommers; Carmen E R M Jacobs; Khaoula Makouri; Johannes J Duvekot; Irwin K M Reiss; Arie Franx; Jolien W Roos-Hesselink; Jérôme M J Cornette Journal: BMC Womens Health Date: 2021-06-19 Impact factor: 2.809
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