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Comparison of Severity-of-Illness Scores in Critically Ill Obstetric Patients: A 6-Year Retrospective Cohort*

Rojas-Suarez, José MD1,2; Paternina-Caicedo, Angel J. MD2; Miranda, Jezid MD2; Mendoza, Ray MD2; Dueñas-Castel, Carmelo MD1,2; Bourjeily, Ghada MD3

doi: 10.1097/CCM.0000000000000124
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Objective: The purpose of this research was to evaluate the discrimination and calibration of mortality prediction of Simplified Acute Physiology Score 2, Simplified Acute Physiology Score 3, Mortality Probability Model II, and Mortality Probability Model III in peripartum women.

Design: A retrospective cohort study.

Setting: Rafael Calvo Maternity Hospital, a large teaching hospital in Cartagena (Colombia).

Patients: All obstetric patients admitted to the ICU from 2006 to 2011.

Interventions: None.

Measurements and Main Results: Seven hundred twenty-six obstetric critical care patients were included. All scores showed good discrimination (area under the receiver operator characteristic curve > 0.86). Simplified Acute Physiology Score 2, Simplified Acute Physiology Score 3, and Mortality Probability Model III inaccurately estimated mortality. The only mortality prediction score that showed good calibration through mortality ratio and Hosmer-Lemeshow test was Mortality Probability Model II. Mortality ratio for Mortality Probability Model II was 0.88 (95% CI, 0.60–1.25). Hosmer-Lemeshow test was not significant (p = 0.571).

Conclusions: Simplified Acute Physiology Score 2 and Simplified Acute Physiology Score 3 overestimate mortality in obstetric critical care patients. Mortality Probability Model III was inadequately calibrated. Mortality Probability Model II showed good fit to predict mortality in a developing country setting. Future studies in developed and developing countries are needed to further confirm our findings.

1Intensive Care Unit, Gestion Salud S.A., Cartagena, Colombia.

2Department of Obstetrics and Gynecology, Grupo de Investigación en Cuidados Intensivos y Obstetricia, GRICIO, Universidad de Cartagena, Cartagena, Colombia.

3Department of Medicine, Women’s Medicine Collaborative, The Miriam Hospital, Brown University, Providence, RI.

* See also p. 1284.

This work was performed at Grupo de Investigación en Cuidados Intensivos y Obstetricia, GRICIO, Universidad de Cartagena.

Dr. Rojas-Suarez had access to full data and is a guarantor that the provided information is sound, trustful, and accord with modern scientific standards. He designed the study, collected and analyzed the data, and prepared the manuscript. Dr. Paternina-Caicedo analyzed the data and prepared the manuscript. Dr. Miranda-Quintero and Dr. Mendoza analyzed the data and contributed to the manuscript. Dr. Dueñas-Castel designed the study and interpreted the results and revised the manuscript. Dr. Bourjeily critically reviewed the manuscript and contributed to the design and interpretation of results. All authors have read and approved the final manuscript.

Dr. Rojas-Suarez received support for travel from Universidad de Cartagena, consulted for Secretaria de Salud de Bolivar, is employed by Gestión Salud SAS, received grant support from Universidad de Cartagena, and lectured for Sociedad Colombiana de Anestesiologia y Reanimación. Dr. Paternina-Caicedo consulted for Clinica Maternidad Rafael Calvo; is employed by Universidad de Cartagena (a grant by Universidad de Cartagena was awarded to GRICIO and Pan American Health Organization awarded a grant to Universidad de Cartagena and lectured for Universidad de Cartagena); and received support for travel from Pan American Health Organization. His institution, Universidad de Cartagena, has a pending grant. Dr. Mendoza is employed by Clínica San Juan De Dios de la Ceja and Nuevo Hospital Bocagrande. Dr. Dueñas-Castel consulted for Linde Health Care and UCI del Caribe, is employed by Universidad de Cartagena and ICU Gestión Salud, and lectured for INSIMED. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins