Abstract
Objective Screening tools, including the Systemic Inflammatory Response Syndrome (SIRS) criteria
and Sequential Organ Failure Assessment (SOFA) criteria, have not been validated in
the pregnant population. We aimed to determine if pregnancy-specific modifications
to the quick SOFA (qSOFA) can improve prediction of severe maternal morbidity in pregnant
women with serious infections.
Study Design We performed a retrospective cohort study of pregnant patients with severe infections
admitted to a single institution from January 1, 2011, through December 31, 2017.
The primary outcome was severe maternal morbidity, defined as a composite of adverse
maternal outcomes: intensive care unit (ICU) admission for >48 hours, need for invasive
monitoring (central line or arterial line), intubation, pharmacologic hemodynamic
support (intravenous vasopressors or inotropes), and/or maternal death. A logistic
regression was then applied and the resulting predictors were analyzed individually
and in combination with receiver operating characteristic (ROC) curves to modify qSOFA
for pregnancy, that is, qSOFA-P.
Results Analysis of 104 pregnant patients with severe infections found that the standard
qSOFA did not accurately predict severe maternal morbidity (ROC area under the curve
[AUC] = 0.54, p = 0.49, sensitivity = 0.38, and specificity = 0.70). Pregnancy-specific modifications
or “qSOFA-P” (respiratory rate [RR] ≥ 35 breaths/minute and systolic blood pressure
[SBP] ≤ 85 mm Hg) significantly improved prediction of severe maternal morbidity (AUC = 0.77,
p < 0.001, sensitivity = 0.79, and specificity = 0.74).
Conclusion The standard qSOFA is a poor screening tool in the prediction of severe maternal
morbidity in pregnant patients with infections. A pregnancy-specific screening system,
qSOFA-P, improved prediction of severe maternal morbidity in pregnant women with severe
infections. Further prospective and large multicenter studies are needed to validate
this scoring system in pregnant women.
Key Points
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Validated scoring systems for evaluating pregnant patients with sepsis are needed.
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Modifications to existing systems may improve the evaluation of pregnant patients
with sepsis.
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The qSOFA-P (RR ≥ 35 breaths/minute and SBP ≤ 85 mm Hg) includes modifications to
qSOFA, and improves the detection of patients who would develop severe maternal morbidity..
Keywords
maternal infection - maternal morbidity and mortality - sepsis - qSOFA - qSOFA-P
