TY - JOUR
T1 - Mechanical ventilation and death in pregnant patients admitted for COVID-19
T2 - a prognostic analysis from the Brazilian COVID-19 registry score
AU - Reis, Zilma Silveira Nogueira
AU - Pires, Magda Carvalho
AU - Ramos, Lucas Emanuel Ferreira
AU - Sales, Thaís Lorenna Souza
AU - Pereira, Polianna Delfino
AU - Martins, Karina Paula Medeiros Prado
AU - Garbini, Andresa Fontoura
AU - dos Reis Gomes, Angélica Gomides
AU - Pessoa, Bruno Porto
AU - Matos, Carolina Cunha
AU - Cimini, Christiane Corrêa Rodrigues
AU - Rempel, Claudete
AU - Ponce, Daniela
AU - Aranha, Felipe Ferraz Martins Graça
AU - Anschau, Fernando
AU - Crestani, Gabriela Petry
AU - Grizende, Genna Maira Santos
AU - Bastos, Gisele Alsina Nader
AU - dos Santos Goedert, Giulia Maria
AU - Menezes, Luanna Silva Monteiro
AU - Carneiro, Marcelo
AU - Tolfo, Marcia Ffner
AU - Corrêa, Maria Augusta Matos
AU - Maciel de Amorim, Mariani
AU - Guimarães Júnior, Milton Henriques
AU - Durães, Pamela Andrea Alves
AU - da Silva Rosa, Patryk Marques
AU - de Lima Martelli, Petrônio José
AU - Santos Charão de Almeida, Rafaela
AU - Martins, Raphael Castro
AU - Alvarenga, Samuel Penchel
AU - Boersma, Eric
AU - Pessoa de Aguiar, Regina Amélia Lopes
AU - Marcolino, Milena Soriano
N1 - Funding
This study was supported in part by Minas Gerais State Agency for Research and Development (Fundação de Amparo à Pesquisa do Estado de Minas Gerais - FAPEMIG) [grant number APQ-00208-20], National Institute of Science and Technology for Health Technology Assessment (Instituto de Avaliação de Tecnologias em Saúde – IATS)/ National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq) [grant numbers 465518/2014-1 and 147122/2021-0], and CAPES Foundation (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) [grant number 88887.507149/2020-00]. ZSNR was partially funded by CNPq Foundation [grant number 305837/2021-4].
Publisher Copyright: © 2023, The Author(s).
PY - 2023/1/10
Y1 - 2023/1/10
N2 - Background: The 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. Methods: This 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. Results: From 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). Conclusions: The 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.
AB - Background: The 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. Methods: This 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. Results: From 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). Conclusions: The 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.
UR - http://www.scopus.com/inward/record.url?scp=85146104871&partnerID=8YFLogxK
U2 - 10.1186/s12884-022-05310-w
DO - 10.1186/s12884-022-05310-w
M3 - Article
C2 - 36627576
AN - SCOPUS:85146104871
SN - 1471-2393
VL - 23
JO - BMC Pregnancy and Childbirth
JF - BMC Pregnancy and Childbirth
IS - 1
M1 - 18
ER -
