Development of the Sepsis-Associated Adverse Outcomes in Pregnancy Score

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Critical Care Medicine

Background:

• Sepsis is a significant cause of maternal morbidity and mortality.
• Early identification of maternal sepsis is crucial for improving outcomes.
• Existing methods for identifying high-risk pregnancies may not be sufficiently sensitive.

Purpose of the Study:

• To develop and validate the Sepsis-Associated Adverse Outcomes in Pregnancy (SAAP) Score.
• To identify pregnant and postpartum individuals at risk for composite maternal adverse outcomes (CMAO) due to infection.
• To provide a tool for early recognition of severe maternal infection.

Main Methods:

• Retrospective cohort study using International Classification of Disease codes.
• Inclusion of pregnant and postpartum individuals with a primary diagnosis of infection.
• Development of a scoring system using regularized logistic regression, evaluating variables for statistical and clinical significance.
• Assessment of model performance using area under the curve (AUC), sensitivity, specificity, and predictive values.

Main Results:

• The study identified 227 individuals meeting inclusion criteria, with 39.2% experiencing CMAO.
• The SAAP score comprises six variables: white blood cell count, systolic blood pressure, respiratory rate, heart rate, lactic acid, and abnormal diagnostic imaging.
• An abnormal SAAP score (≥7) demonstrated an AUC of 0.80 for predicting CMAO, with a sensitivity of 0.71 and specificity of 0.73.

Conclusions:

• The SAAP score, comprising six variables, shows promise for early recognition of pregnant and postpartum individuals with infection likely to develop adverse maternal outcomes.
• Pending external validation, the SAAP score can aid clinicians in identifying high-risk patients for timely intervention.
• The score's performance metrics suggest its utility in improving maternal sepsis management.