The Usefulness of the APACHE II Score in Obstetric Critical Care: A Structured Review

Ryan, Helen; Sharma, Sumedha; Magee, Laura A.; Ansermino, J. Mark; MacDonell, Karen L.; Payne, Beth; Walley, Keith R.; Dadelszen, Peter von

doi:10.1016/j.jogc.2016.06.013

Cited by 34 publications

(25 citation statements)

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“…Initially, we performed a structured literature review of existing critical care outcome prediction models and their evidence for use in pregnancy to identify candidate predictor variables [1]. This review has been published elsewhere [1].…”

Section: Methodsmentioning

confidence: 99%

“…This review has been published elsewhere [1]. Variables considered for the CIPHER model included patient demographic details, prior health status, indication for ICU admission, and clinical and laboratory measurements taken in the first 24 h following ICU admission.…”

Section: Methodsmentioning

confidence: 99%

“…Most women who die during or soon after pregnancy in a health facility do so in an intensive care unit (ICU), if one is available [1–3]. Maternal ICU admissions result from both obstetric and non-obstetric complications in pregnancy; about two thirds of admissions are due to obstetric causes, such as hemorrhage, pre-eclampsia, and sepsis, and one third are due to maternal medical or surgical complications [1–3].…”

Section: Introductionmentioning

confidence: 99%

“…Maternal ICU admissions result from both obstetric and non-obstetric complications in pregnancy; about two thirds of admissions are due to obstetric causes, such as hemorrhage, pre-eclampsia, and sepsis, and one third are due to maternal medical or surgical complications [1–3]. …”

Section: Introductionmentioning

confidence: 99%

“…However, most ICU outcome prediction models were designed in general critical care populations in high-income countries (HICs) and their use in obstetric populations and in low- and middle-income countries (LMICs) is contentious. These general ICU prediction rules tend to overestimate the risk of maternal death by up to 20-fold [1]. The two exceptions to this are the SOFA score for sepsis risk and the Maternal Severity Index rule [9, 10].…”

Section: Introductionmentioning

confidence: 99%

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Development and internal validation of the multivariable CIPHER (Collaborative Integrated Pregnancy High-dependency Estimate of Risk) clinical risk prediction model

et al. 2018

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BackgroundIntensive care unit (ICU) outcome prediction models, such as Acute Physiology And Chronic Health Evaluation (APACHE), were designed in general critical care populations and their use in obstetric populations is contentious. The aim of the CIPHER (Collaborative Integrated Pregnancy High-dependency Estimate of Risk) study was to develop and internally validate a multivariable prognostic model calibrated specifically for pregnant or recently delivered women admitted for critical care.MethodsA retrospective observational cohort was created for this study from 13 tertiary facilities across five high-income and six low- or middle-income countries. Women admitted to an ICU for more than 24 h during pregnancy or less than 6 weeks post-partum from 2000 to 2012 were included in the cohort. A composite primary outcome was defined as maternal death or need for organ support for more than 7 days or acute life-saving intervention. Model development involved selection of candidate predictor variables based on prior evidence of effect, availability across study sites, and use of LASSO (Least Absolute Shrinkage and Selection Operator) model building after multiple imputation using chained equations to address missing data for variable selection. The final model was estimated using multivariable logistic regression. Internal validation was completed using bootstrapping to correct for optimism in model performance measures of discrimination and calibration.ResultsOverall, 127 out of 769 (16.5%) women experienced an adverse outcome. Predictors included in the final CIPHER model were maternal age, surgery in the preceding 24 h, systolic blood pressure, Glasgow Coma Scale score, serum sodium, serum potassium, activated partial thromboplastin time, arterial blood gas (ABG) pH, serum creatinine, and serum bilirubin. After internal validation, the model maintained excellent discrimination (area under the curve of the receiver operating characteristic (AUROC) 0.82, 95% confidence interval (CI) 0.81 to 0.84) and good calibration (slope of 0.92, 95% CI 0.91 to 0.92 and intercept of −0.11, 95% CI −0.13 to −0.08).ConclusionsThe CIPHER model has the potential to be a pragmatic risk prediction tool. CIPHER can identify critically ill pregnant women at highest risk for adverse outcomes, inform counseling of patients about risk, and facilitate bench-marking of outcomes between centers by adjusting for baseline risk.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2215-6) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Development and internal validation of the multivariable CIPHER (Collaborative Integrated Pregnancy High-dependency Estimate of Risk) clinical risk prediction model

et al. 2018

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Identifying the Critically Ill Parturient

Padilla

Easter

Bateman

2020

Principles and Practice of Maternal Critical Care

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Near-Miss Incidents in Obstetric Patients Admitted to an Intensive Care Unit of a Tertiary Care Center in Eastern India: A Retrospective Cohort Study

Joshi

Saraswat

et al. 2021

J Obstet Gynecol India

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Aim Obstetric patients presenting to the intensive care units (ICU) with or without underlying medical or surgical comorbidities can be a challenge to both the treating obstetrician and the intensivist. They occasionally present with near-miss events which if left untreated, can result in death. Objectives To study the prevalence, indications of ICU admissions, near-miss events, and their effect on mortality in obstetric and puerperal patients . Material & methods We conducted a retrospective analysis of the health records of all the obstetric and puerperal patients (pregnant and until 6 weeks postpartum) admitted to our tertiary care hospital from January 2019 to December 2020. Patient demographic characteristics, obstetric, surgical, and medical conditions, acute physiology, and chronic health evaluation (APACHE) II scores, organ failures, treatment, ICU and hospital length of stay, and mortality outcomes were studied. Results A total of 22 obstetric patients were admitted to the ICU during the above study period. Mean age was 28.7 ± 6.24 years, mean gestation was 34.4 ± 6.61 weeks, mean APACHE II score was 12.68 ± 5.67, median ICU length of stay was 5 days, and median duration of hospital length of stay was 10 days. The antepartum risk factors such as severe preeclampsia (27%), antepartum bleeding (14%), and postpartum complications like postpartum haemorrhage (33%), sepsis with multiorgan failure (25%) are the commonest indications that resulted in ICU admission. Conclusion Higher APACHE II scores at the time of ICU admission, prolonged ICU, and hospital length of stay may be associated with high maternal mortality.

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The Usefulness of the APACHE II Score in Obstetric Critical Care: A Structured Review

Abstract: 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.

Cited by 34 publications

References 30 publications

Development and internal validation of the multivariable CIPHER (Collaborative Integrated Pregnancy High-dependency Estimate of Risk) clinical risk prediction model

Development and internal validation of the multivariable CIPHER (Collaborative Integrated Pregnancy High-dependency Estimate of Risk) clinical risk prediction model

Identifying the Critically Ill Parturient

Near-Miss Incidents in Obstetric Patients Admitted to an Intensive Care Unit of a Tertiary Care Center in Eastern India: A Retrospective Cohort Study

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