Quick Sequential Organ Failure Assessment: Modifications for Identifying Maternal Morbidity and Mortality in...

Area of Science:

• Obstetrics and Gynecology
• Critical Care Medicine
• Infectious Diseases

Background:

• Existing sepsis screening tools like SIRS and SOFA lack validation in pregnant populations.
• Accurate prediction of severe maternal morbidity in pregnant women with infections is crucial for timely intervention.

Purpose of the Study:

• To evaluate the predictive performance of the standard quick SOFA (qSOFA) for severe maternal morbidity in pregnant women with serious infections.
• To develop and validate a pregnancy-specific modification of qSOFA (qSOFA-P) to improve prediction of severe maternal morbidity.

Main Methods:

• Retrospective cohort study of 104 pregnant patients with severe infections from 2011-2017.
• Severe maternal morbidity defined as ICU admission >48 hours, invasive monitoring, intubation, hemodynamic support, or death.
• Logistic regression and ROC curve analysis used to modify qSOFA for pregnancy (qSOFA-P).

Main Results:

• Standard qSOFA showed poor predictive accuracy for severe maternal morbidity (AUC=0.54).
• The pregnancy-specific qSOFA-P (RR ≥ 35, SBP ≤ 85 mmHg) significantly improved prediction (AUC=0.77, p<0.001).
• qSOFA-P demonstrated higher sensitivity (0.79) and specificity (0.74) compared to standard qSOFA.

Conclusions:

• The standard qSOFA is an unreliable tool for screening pregnant women with infections for severe morbidity.
• The qSOFA-P offers improved prediction of severe maternal morbidity in this population.
• Further prospective, multicenter studies are warranted to validate the qSOFA-P scoring system.