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

• Main Authors: Zilma Silveira Nogueira Reis (Author), Magda Carvalho Pires (Author), Lucas Emanuel Ferreira Ramos (Author), Thaís Lorenna Souza Sales (Author), Polianna Delfino Pereira (Author), Karina Paula Medeiros Prado Martins (Author), Andresa Fontoura Garbini (Author), Angélica Gomides dos Reis Gomes (Author), Bruno Porto Pessoa (Author), Carolina Cunha Matos (Author), Christiane Corrêa Rodrigues Cimini (Author), Claudete Rempel (Author), Daniela Ponce (Author), Felipe Ferraz Martins Graça Aranha (Author), Fernando Anschau (Author), Gabriela Petry Crestani (Author), Genna Maira Santos Grizende (Author), Gisele Alsina Nader Bastos (Author), Giulia Maria dos Santos Goedert (Author), Luanna Silva Monteiro Menezes (Author), Marcelo Carneiro (Author), Marcia Ffner Tolfo (Author), Maria Augusta Matos Corrêa (Author), Mariani Maciel de Amorim (Author), Milton Henriques Guimarães Júnior (Author), Pamela Andrea Alves Durães (Author), Patryk Marques da Silva Rosa (Author), Petrônio José de Lima Martelli (Author), Rafaela Santos Charão de Almeida (Author), Raphael Castro Martins (Author), Samuel Penchel Alvarenga (Author), Eric Boersma (Author), Regina Amélia Lopes Pessoa de Aguiar (Author), Milena Soriano Marcolino (Author)
• Format: Book
• Published: BMC, 2023-01-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 10.1186/s12884-022-05310-w; 1471-2393
• Keywords: COVID-19; Pregnant women; Clinical decision rules; Mortality; Artificial respiration; Prognosis; Gynecology and obstetrics; RG1-991
• Source: BMC Pregnancy and Childbirth, Vol 23, Iss 1, Pp 1-12 (2023)

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.