Comparison of four prognostic scales for predicting mortality in patients with severe maternal morbidity.

Objective: To compare the prognostic validity of the APACHE II-M and O-SOFA scales versus the APACHE II and SOFA to predict mortality in patients with severe maternal morbidity.

Design: A retrospective, longitudinal and analytical cohort study was carried out. Setting: Medical-surgical intensive care unit (ICU) of a tertiary hospital. Patients: Pregnant or puerperal patients of any age admitted to the ICU. Interventions: Calculation of prognostic scores upon admission. Variables of interest: APACHE II, SOFA, APACHE II-M and O-SOFA scores and maternal mortality.

Results: A total of 141 patients were included. The majority (70.2%) were puerperal. The most frequent diagnosis was gestational hypertensive disease (50 cases). The discrimination of each prognostic model was estimated with the area under the ROC curve (AUC-ROC). The calibration was estimated using the mortality ratio and the Hosmer-Lemeshow statistic. The four scales discriminated between survivors and non-survivors with areas under the curve >0.85. The APACHE II-M model was the predictive model with the highest discrimination and calibration. In the Hosmer-Lemeshow regression analysis, mortality as predicted by the APACHE II and O-SOFA was significantly different from the observed mortality.

Conclusions: The APACHE II-M exhibited the greatest prognostic validity in predicting maternal mortality. This difference was given by its improvement in calibration.