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

Author:

Reis Zilma Silveira NogueiraORCID,Pires Magda CarvalhoORCID,Ramos Lucas Emanuel FerreiraORCID,Sales Thaís Lorenna SouzaORCID,Delfino-Pereira PoliannaORCID,Martins Karina Paula Medeiros PradoORCID,Garbini Andresa FontouraORCID,Gomes Angélica Gomides dos ReisORCID,Pessoa Bruno PortoORCID,Matos Carolina CunhaORCID,Cimini Christiane Corrêa RodriguesORCID,Rempel ClaudeteORCID,Ponce DanielaORCID,Aranha Felipe Ferraz Martins GraçaORCID,Anschau FernandoORCID,Crestani Gabriela PetryORCID,Grizende Genna Maira SantosORCID,Bastos Gisele Alsina NaderORCID,Goedert Giulia Maria dos SantosORCID,Menezes Luanna Silva MonteiroORCID,Carneiro MarceloORCID,Tolfo Marcia FfnerORCID,Corrêa Maria Augusta MatosORCID,Amorim Mariani Maciel deORCID,Guimarães Júnior Milton HenriquesORCID,Durães Pamela Andrea AlvesORCID,Rosa Patryk Marques da SilvaORCID,Martelli Petrônio José de LimaORCID,Almeida Rafaela Santos Charão deORCID,Martins Raphael CastroORCID,Alvarenga Samuel PenchelORCID,Boersma EricORCID,Aguiar Regina Amélia Lopes Pessoa deORCID,Marcolino Milena SorianoORCID

Abstract

Abstract 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.

Funder

Fundação de Amparo à Pesquisa do Estado de Minas Gerais

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Publisher

Springer Science and Business Media LLC

Subject

Obstetrics and Gynecology

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