Mechanical ventilation and death in pregnant patients admitted for COVID-19: a prognostic analysis from the Brazilian COVID-19 registry score

BMC Pregnancy and Childbirth

Research Article

Daniela Ponce¹  Patryk Marques da Silva Rosa²  Petrônio José de Lima Martelli³  Eric Boersma⁴  Zilma Silveira Nogueira Reis⁵  Regina Amélia Lopes Pessoa de Aguiar⁵  Polianna Delfino Pereira⁶  Milena Soriano Marcolino⁷  Lucas Emanuel Ferreira Ramos⁸  Magda Carvalho Pires⁸  Marcia Ffner Tolfo⁹  Carolina Cunha Matos^1,10  Angélica Gomides dos Reis Gomes^1,11  Claudete Rempel^1,12  Bruno Porto Pessoa^1,13  Luanna Silva Monteiro Menezes^1,14  Gisele Alsina Nader Bastos^1,15  Milton Henriques Guimarães Júnior^1,16  Gabriela Petry Crestani^1,17  Andresa Fontoura Garbini^1,18  Rafaela Santos Charão de Almeida^1,18  Fernando Anschau^1,18  Felipe Ferraz Martins Graça Aranha^1,19  Genna Maira Santos Grizende^2,20  Marcelo Carneiro^2,21  Christiane Corrêa Rodrigues Cimini^2,22  Raphael Castro Martins^2,23  Giulia Maria dos Santos Goedert^2,24  Maria Augusta Matos Corrêa^2,25  Pamela Andrea Alves Durães^2,26  Thaís Lorenna Souza Sales^2,27  Samuel Penchel Alvarenga^2,27  Mariani Maciel de Amorim^2,28  Karina Paula Medeiros Prado Martins^2,29 

[1] Botucatu Medical School, Universidade Estadual Paulista “Júlio de Mesquita Filho” and Hospital das Clínicas da Faculdade de Medicina de Botucatu, Av. Prof. Mário Rubens Guimarães Montenegro, s/n, Botucatu, Brazil;Centro Universitário de Belo Horizonte, Av. Professor Werneck, 1685, Belo Horizonte, Brazil;Centro de Ciências Médicas, Universidade Federal de Pernambuco, Hospital das Clínicas da Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235, Recife, Brazil;Department of Cardiology, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands;Department of Gynecology and Obstetrics, University Hospital. Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil;Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil;Institute for Health Technology Assessment (IATS/CNPq), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil;Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil;Institute for Health Technology Assessment (IATS/CNPq), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil;University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil;Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena 190, Belo Horizonte, Brazil;Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil;Faculdade Integrada de Santa Maria, R. José do Patrocínio, 26, Santa Maria, Brazil;Faculdade de Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias, 275, Belo Horizonte, Brazil;Hospitais da Rede Mater Dei, Av. do Contorno, 9000, Belo Horizonte, Brazil;Hospital Bruno Born, Av. Benjamin Constant, 881, Lajeado, Brazil;Hospital Júlia Kubitschek, R. Dr. Cristiano Rezende, 2745, Belo Horizonte, Brazil;Hospital Metropolitano Odilon Behrens, R. Formiga, 50, Belo Horizonte, Brazil;Hospital Moinhos de Vento, R. Ramiro Barcelos, 910, Porto Alegre, Brazil;Hospital Márcio Cunha, Av. Kiyoshi Tsunawaki, 41, Ipatinga, Brazil;Hospital Mãe de Deus, R. José de Alencar, 286, Porto Alegre, Brazil;Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil;Hospital SOS Cardio, Rodovia, SC-401, 121, Florianópolis, Brazil;Hospital Santa Casa de Misericórdia de Belo Horizonte, Av. Francisco Sales, 1111, Belo Horizonte, Brazil;Hospital Santa Cruz, R. Fernando Abott, 174, Santa Cruz do Sul, Brazil;Hospital Santa Rosália, R. Dr. Onófre, 575, Teófilo Otoni, Brazil;Mucuri Medical School, Universidade Federal dos Vales do Jequitinhonha e Mucuri, R. Cruzeiro, 01, Teófilo Otoni, Brazil;Hospital Tacchini, R. Dr. José Mário Mônaco, 358, Bento Gonçalves, Brazil;Medical School, Universidade Federal de Santa Maria, Av. Roraima, 1000, Santa Maria, Brazil;Mucuri Medical School, Universidade Federal dos Vales do Jequitinhonha e Mucuri, R. Cruzeiro, 01, Teófilo Otoni, Brazil;Pontifícia Universidade Católica de Minas Gerais, R. do Rosário, 1081, Betim, Brazil;Universidade Federal de São João del-Rei, R. Sebastião Gonçalves Coelho, 400, Chanadour, 35501-296, Divinópolis, MG, Brazil;Universidade Luterana do Brasil, Av. Farroupilha, 8001, Canoas, Brazil;University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil;

关键词: COVID-19;    Pregnant women;    Clinical decision rules;    Mortality;    Artificial respiration;    Prognosis;   

DOI  :  10.1186/s12884-022-05310-w

 received in 2021-11-02, accepted in 2022-12-14,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundThe assessment of clinical prognosis of pregnant COVID-19 patients at hospital presentation is challenging, due to physiological adaptations during pregnancy. Our aim was to assess the performance of the ABC2-SPH score to predict in-hospital mortality and mechanical ventilation support in pregnant patients with COVID-19, to assess the frequency of adverse pregnancy outcomes, and characteristics of pregnant women who died.MethodsThis multicenter cohort included consecutive pregnant patients with COVID-19 admitted to the participating hospitals, from April/2020 to March/2022. Primary outcomes were in-hospital mortality and the composite outcome of mechanical ventilation support and in-hospital mortality. Secondary endpoints were pregnancy outcomes. The overall discrimination of the model was presented as the area under the receiver operating characteristic curve (AUROC). Overall performance was assessed using the Brier score.ResultsFrom 350 pregnant patients (median age 30 [interquartile range (25.2, 35.0)] years-old]), 11.1% had hypertensive disorders, 19.7% required mechanical ventilation support and 6.0% died. The AUROC for in-hospital mortality and for the composite outcome were 0.809 (95% IC: 0.641–0.944) and 0.704 (95% IC: 0.617–0.792), respectively, with good overall performance (Brier = 0.0384 and 0.1610, respectively). Calibration was good for the prediction of in-hospital mortality, but poor for the composite outcome. Women who died had a median age 4 years-old higher, higher frequency of hypertensive disorders (38.1% vs. 9.4%, p < 0.001) and obesity (28.6% vs. 10.6%, p = 0.025) than those who were discharged alive, and their newborns had lower birth weight (2000 vs. 2813, p = 0.001) and five-minute Apgar score (3.0 vs. 8.0, p < 0.001).ConclusionsThe ABC2-SPH score had good overall performance for in-hospital mortality and the composite outcome mechanical ventilation and in-hospital mortality. Calibration was good for the prediction of in-hospital mortality, but it was poor for the composite outcome. Therefore, the score may be useful to predict in-hospital mortality in pregnant patients with COVID-19, in addition to clinical judgment. Newborns from women who died had lower birth weight and Apgar score than those who were discharged alive.

【 授权许可】

CC BY   
© The Author(s) 2023

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