Development of the Sepsis-Associated Adverse Outcomes in Pregnancy Score

Angela J. Stephens; Kyung H. Lee; John R. Barton; Suneet P. Chauhan; Andrea L. Baker; Baha M. Sibai

doi:10.1055/a-1884-1001

American Journal of Perinatology, Table of Contents

Am J Perinatol 2023; 40(02): 128-136
DOI: 10.1055/a-1884-1001

SMFM Fellowship Series Articles

Development of the Sepsis-Associated Adverse Outcomes in Pregnancy Score

Angela J. Stephens

¹Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas

,

Kyung H. Lee

²Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas

,

John R. Barton

³Division of Maternal-Fetal Medicine, Baptist Health Lexington, Lexington, Kentucky

,

Suneet P. Chauhan

¹Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas

,

Andrea L. Baker

¹Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas

,

Baha M. Sibai

¹Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas

› Author Affiliations

Abstract

Objective This study aimed to develop and evaluate a scoring system—called the Sepsis-Associated Adverse Outcomes in Pregnancy (SAAP) Score—to identify individuals with maternal infection that have composite maternal adverse outcomes (CMAO).

Study Design Using the International Classification of Disease codes, we identified pregnant and postpartum (up to 6 weeks after birth) individuals admitted at our center with a primary diagnosis of infection. The primary outcome was CMAO which included any of the following: maternal intensive care unit admission, surgical intervention, vasopressor use, acute respiratory distress syndrome, pulmonary edema, mechanical ventilation, high-flow nasal cannula, disseminated intravascular coagulation, dialysis, organ failure, venous thromboembolism, or maternal death. Regularized logistic regression was used to identify variables that best discriminate CMAO status. Variables were chosen for inclusion following evaluation of statistical and clinical significance. Model performance was evaluated using area under the curve (AUC) with 95% confidence intervals (CIs), sensitivity, specificity, and predictive values.

Results Of the 23,235 deliveries during the study period, 227 (0.9%) individuals met inclusion criteria and among them CMAO occurred in 39.2% (95% CI: 33.1–45.7%). The SAAP score consisted of six variables (white blood cell count, systolic blood pressure, respiratory rate, heart rate, lactic acid, and abnormal diagnostic imaging) with scores ranging from 0 to 11 and a score of ≥7 being abnormal. An abnormal SAAP score had an AUC of 0.80 (95% CI: 0.74–0.86) for CMAO. The sensitivity and specificity of the SAAP score for CMAO was 0.71 (95% CI: 0.60–0.80) and 0.73 (95% CI: 0.64–0.80), respectively. The positive predictive value was 0.62 (95% CI: 0.52–0.72) and negative predictive value was 0.79 (95% CI: 0.71–0.86).

Conclusion Pending external validation, the sixth variable SAAP score may permit early recognition of pregnant and postpartum individuals with infection who are likely to develop adverse maternal outcomes.

Key Points

Sepsis is a leading cause of maternal morbidity and mortality.
Early recognition improves maternal sepsis outcomes.
The SAAP score may permit early recognition of maternal adverse outcomes due to infection.

Keywords

sepsis - maternal sepsis - sepsis in pregnancy - maternal morbidity - maternal mortality

Full Text

References

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Supplementary Material

Supplementary Material