产科早期预警评分系统应用于产科ICU患者的评估

Application of Obstetric Early Warning Score in Obstetric ICU-Admitted Patients

目的:综合评估英国国家重症监护审计和研究中心(ICNARC)-产科早期预警评分(OEWS)系统对入住重症监护病房(ICU)孕产妇发生产科危重症的预测能力。方法:对2015年1月-2018年5月苏州市立医院本部(我院)入住ICU孕产妇共214例进行回顾性队列研究,采用入ICU 24 h内的数据计算OEWS分值,预测其住院期间发生产科危重症的可能性,综合评估ICNARC-OEWS的性能、区分度和分层能力。结果:研究期间,共有67 148例孕妇在我院分娩,其中214例孕产妇入住ICU,ICU入住率3.19/1 000,其中2例死亡,孕产妇死亡率为2.98/100 000,97例发生危重症,危重症发生率为1.44/1 000。最常见的入住ICU原因为直接产科因素(74.3%,159/214)。发生产科危重症的孕产妇OEWS评分显著高于无危重症孕产妇[7(6,9)vs. 4(1,5),Z=-10.340,P=0.000]。OEWS评分为0分的孕产妇无产科危重症发生,1~3分时阴性预测值(NPV)为94.5%(52/55),≥6分时阳性预测值(PPV)为79.0%(83/105)。OEWS区分产科危重症的受试者工作特征(ROC)曲线下面积(AUC)为0.908(95%CI:0.870~0.946,P<0.001),预测因间接和直接产科因素入住ICU孕产妇发生危重症的AUC分别为0.875(95%CI:0.784~0.966)和0.920(95%CI:0.879~0.961,P<0.001)。结论:ICNARC-OEWS系统对于ICU孕产妇发生产科危重症具有良好的区分能力和分层能力,可以在ICU的围生期妇女中推广。

Objective:To evaluate the efficiency of the obstetric early warning score(OEWS) from Intensive Care National Audit and Research Centre(ICNARC)Case Mix Program(CMP)(ICNARC-OEWS) for predicting the obstetric critical diseases in peripartal women who admitted to intensive care unit(ICU). Methods:This is a retrospective cohort study on the peripartal women who admitted to ICU with direct and indirect obstetric-related causes at Suzhou Municipal Hospital from Jan 2015 to May 2018. According to ICNARC-OEWS,the score was calculated on the basis of the clinical data collected during the first 24 hours of ICU admission. The aggregate performance of ICNARC-OEWS in predicting the discrimination and risk stratification was evaluated.Results: During the study period, 67 148 deliveries were recorded. There were 214 women who admitted to obstetric ICU, with the rate of ICU admission 3.19/1 000. In total, there were 2 maternal death and 97 severe maternal morbidity, with the rates of the mortality and sever morbidity 2.98/100 000 and 1.44/1 000 respectively.The most frequent causes of ICU admission were the direct obstetrical-related conditions. The OEWS score was significantly higher in women with severe morbidity than those without [7(6, 9) vs. 4(1, 5),Z=-10.340, P=0.000].Peripartal women with normal OEWS had 0% severe morbidity. The negative predictive value(NPV) in women with 1-3 score of OEWS was 94.5%(52/55), while the positive predictive value(PPV) in women with ≥6 score of OEWS was 79%(83/105). The area under curve(AUC) of the receiver operating characteristic curve(ROC) based on OEWS was used to discriminate the severe maternal morbidity with the efficiency of 0.908(95% CI: 0.870-0.946, P<0.001). The AUC values were 0.875(95%CI:0.784-0.966) and 0.920(95%CI:0.879-0.961)in the ICU-admitted women with indirect factors and those women with direct factors, respectively(P <0.001).Conclusions: Our results suggested that the performance of ICNARC-OEWS in the discrimination and risk stratification of severe maternal morbidity was good in those obstetric ICU-admitted women, and that the ICNARC-OEWS could be promoted to use in the obstetric ICU-admitted women.