Abstract
Objectives
We aimed to establish new cut-off values for SIRS (Systemic Inflammatory Response Syndrome) variables in the obstetric population.
Methods
A prospective cohort study in pregnant and postpartum women admitted with systemic infections between December 2017 and January 2019. Patients were divided into three cohorts: Group A, patients with infection but without severe maternal outcomes (SMO); Group B, patients with infection and SMO or admission to the intensive care unit (ICU); and Group C, a control group. Outcome measures were ICU admission and SMO. The relationship between SIRS criteria and SMO was expressed as the area under the receiver operating characteristics curve (AUROC), selecting the best cut-off for each SIRS criterion.
Results
A total of 541 obstetric patients were enrolled, including 341 with infections and 200 enrolled as the reference group (Group C). The patients with infections included 313 (91.7%) in Group A and 28 (8.2%) in Group B. There were significant differences for all SIRS variables in Group B, compared with Groups A and C, but there were no significant differences between Groups A and C. The best cut-off values were the following: temperature 38.2 °C, OR 4.1 (1.8–9.0); heart rate 120 bpm, OR 2.9 (1.2–7.4); respiratory rate 22 bpm, OR 4.1 (1.6–10.1); and leukocyte count 16,100 per mcl, OR 3.5 (1.6–7.6).
Conclusions
The cut-off values for SIRS variables did not differ between healthy and infected obstetric patients. However, a higher cut-off may help predict the population with a higher risk of severe maternal outcomes.
Funding source: Ministerio de Ciencia, Tecnologia e Innovación (MINCIENCIAS) http://dx.doi.org/10.13039/100007637
Award Identifier / Grant number: grant #815/2017
Funding source: Universidad de Cartagena
Award Identifier / Grant number: grant #02565/2017
Acknowledgments
A preliminary report of this data was presented at the North American Society of Obstetric Medicine Annual meeting on March 29th and 30th, 2019, in Vancouver, Canada.
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Research funding: This research was funded by the Universidad de Cartagena [grant #02565/2017] and Ministerio de Ciencia, Tecnologia e Innovación (MINCIENCIAS) [grant #815/2017].
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Ethical approval: The Ethics Committee of Universidad de Cartagena and the Institutional Review Board of CMRC approved this study.
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Data availability: The patient data used to support the findings of this study are restricted by the Institutional Review Board of CMRC in order to protect patient privacy. Data are available from [Jose Rojas-Suarez, joseantonio.rojas.suarez@gricio.com] for researchers who meet the criteria for access to confidential data.
References
1. Say, L, Chou, D, Gemmill, A, Tunçalp, Ö, Beth Moller, A, Daniels, J, et al.. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Heal 2014;2:e323–33. https://doi.org/10.1016/s2214-109x(14)70227-x.Search in Google Scholar
2. Rudd, KE, Johnson, SC, Agesa, KM, Shackelford, K, Tsoi, D, Rhodes, D, et al.. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet 2020;395:200–1. https://doi.org/10.1016/s0140-6736(19)32989-7.Search in Google Scholar
3. The WHO Global Maternal Sepsis Study (GLOSS) Research Group. Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study. Lancet Glob Health 2020;8:e661–71. https://doi.org/10.1016/S2214-109X(20)30109-1.Search in Google Scholar
4. De La Torre, A, Nikoloski, Z, Mossialos, E. Equity of access to maternal health interventions in Brazil and Colombia: a retrospective study. Int J Equity Health 2018;17:43. https://doi.org/10.1186/s12939-018-0752-x.Search in Google Scholar
5. Brizuela, V, Bonet, M, Trigo Romero, CL, Abalos, E, Baguiya, A, Fawole, B, et al.. Early evaluation of the “STOP SEPSIS!” WHO Global Maternal Sepsis Awareness Campaign implemented for healthcare providers in 46 low, middle and high-income countries. BMJ Open 2020;10:e036338. https://doi.org/10.1136/bmjopen-2019-036338.Search in Google Scholar
6. Maguire, PJ, Power, KA, Downey, AF, O’Higgins, AC, Sheehan, SR, Turner, MJ. Evaluation of the systemic inflammatory response syndrome criteria for the diagnosis of sepsis due to maternal bacteremia. Int J Gynecol Obstet 2016;133:116–9. https://doi.org/10.1016/j.ijgo.2015.09.017.Search in Google Scholar
7. Singer, M, Deutschman, CS, Seymour, C, Shankar-Har, M, Annane, D, Bauer, M, et al.. The third international consensus definitions for sepsis and septic shock (sepsis-3). J Am Med Assoc 2016;8:801–10. https://doi.org/10.1001/jama.2016.0287.Search in Google Scholar
8. Vincent, JL, Martin, GS, Levy, MM. qSOFA does not replace SIRS in the definition of sepsis. Crit Care 2016;20:210. Published online. https://doi.org/10.1186/s13054-016-1389-z.Search in Google Scholar
9. Franchini, S, Scarallo, L, Carlucci, M, Cabrini, L, Tresoldi, M. SIRS or qSOFA? Is that the question? clinical and methodological observations from a meta-analysis and critical review on the prognostication of patients with suspected sepsis outside the ICU. Intern Emerg Med 2019;14:593–602. https://doi.org/10.1007/s11739-018-1965-0.Search in Google Scholar
10. Goulden, R, Hoyle, MC, Monis, J, Railton, D, Riley, V, Martin, P, et al.. QSOFA, SIRS and NEWS for predicting inhospital mortality and ICU admission in emergency admissions treated as sepsis. Emerg Med J 2018;35:345–9. Published online. https://doi.org/10.1136/emermed-2017-207120.Search in Google Scholar
11. Bauer, ME, Bauer, ST, Rajala, B, MacEachern, M, Polley, L, Childers, D, et al.. Maternal physiologic parameters in relationship to systemic inflammatory response syndrome criteria: a systematic review and meta-analysis. Obstet Gynecol 2014;124:535–41. https://doi.org/10.1097/aog.0000000000000423.Search in Google Scholar
12. Woodd, SL, Montoya, A, Barreix, M, Pi, L, Calvert, C, Rehman, A, et al.. Incidence of maternal peripartum infection: a systematic review and meta-analysis. PLoS Med 2019;12:e1002984. https://doi.org/10.1371/journal.pmed.1002984.Search in Google Scholar
13. Escobar, MF, Nasner, D, Hurtado, CF, Fernández, PA, Echavarria, MP. Characterization of obstetric patients with sepsis identified by two diagnostic scales at a fourth-level clinic in Colombia. Int J Gynecol Obstet 2018;143:71–6. https://doi.org/10.1002/ijgo.12580.Search in Google Scholar
14. Green, LJ, Mackillop, LH, Salvi, D, Pullon, R, Loerup, L, Tarassenko, L, et al.. Gestation-specific vital sign reference ranges in pregnancy. Obstet Gynecol 2020;135:653–64. https://doi.org/10.1097/aog.0000000000003721.Search in Google Scholar
15. Sohn, CH, Kim, Y-J, Seo, DW, Won, HS, Shim, JY, Lim, KS, et al.. Blood lactate concentration and shock index associated with massive transfusion in emergency department patients with primary postpartum haemorrhage. Br J Anaesth 2018;121:378–83. https://doi.org/10.1016/j.bja.2018.04.039.Search in Google Scholar
16. Luo, J, Jiang, W, Weng, L, Peng, J, Hu, X, Wang, C, et al.. Usefulness of qSOFA and SIRS scores for detection of incipient sepsis in general ward patients: a prospective cohort study. J Crit Care 2019;51:13–8. https://doi.org/10.1016/j.jcrc.2019.01.012.Search in Google Scholar
17. Albright, CM, Ali, TN, Lopes, V, Rouse, DJ, Anderson, BL. The Sepsis in Obstetrics Score: a model to identify risk of morbidity from sepsis in pregnancy. Am J Obstet Gynecol 2014;211:39.E1–8. https://doi.org/10.1016/j.ajog.2014.03.010.Search in Google Scholar
18. Albright, CM, Has, P, Rouse, DJ, Hughes, BL. Internal validation of the sepsis in obstetrics score to identify risk of morbidity from sepsis in pregnancy. Obstet Gynecol 2017;130:747–55. https://doi.org/10.1097/aog.0000000000002260.Search in Google Scholar
19. Agarwal, R, Yadav, RK, Mohta, M, Sikka, M, Radhakrishnan, G. Sepsis in Obstetrics Score (SOS) utility and validation for triaging patients with obstetric sepsis in the emergency department: evidence from a low income health care setting. Obstet Med 2019;12:90–6. https://doi.org/10.1177/1753495x18761522.Search in Google Scholar
Supplementary Material
The online version of this article offers supplementary material (https://doi.org/10.1515/jpm-2021-0135).
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