title: Evaluation of standard and modified severity of illness scores in the obstetric patient.
abstract: OBJECTIVE
  To test discrimination and calibration of APACHE-II and SAPS-II risk prediction scores in a cohort of obstetric patients, and to evaluate the effect of modifying these scores for the physiological changes in pregnancy.
  
  
  METHODS
  A retrospective review of obstetric patients, 12 weeks gestation to 48 hours postpartum, admitted to the ICU for more than 24 hours. APACHE-II and SAPS-II, and versions modified for the physiological changes of pregnancy, were evaluated by receiver operating characteristic (ROC) curves and standardized mortality ratios (SMR). Multivariable analysis identified other parameters associated with mortality.
  
  
  RESULTS
  Data were obtained from 332 patients from 5 countries, with a mortality rate of 12%. Mean (± SD) APACHE-II score was 16.8 ± 6.1 and SAPS-II score 26.5 ± 15.8. Good discrimination was demonstrated with area under the ROC curves of 0.82 and 0.78 respectively, with no improvement after modification for altered maternal physiology. APACHE-II overestimated mortality, with an SMR of 0.43 (0.52 after including diagnostic weighting) compared with 0.89 for SAPS-II. Bilirubin, albumin and Glasgow Coma Scale were independently associated with mortality.
  
  
  CONCLUSIONS
  APACHE-II and SAPS-II are good discriminators of illness severity and may be valuable for comparing obstetric cohorts, but APACHE-II significantly over-estimates mortality.
authors.affiliation: Intensive Care Unit, Mount Sinai Hospital and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada M5G 1X5. Electronic address: stephen.lapinsky@utoronto.ca.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Lapinsky
authors.affiliation: Intensive Care Unit, Mount Sinai Hospital and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada M5G 1X5.
authors.forename: David
authors.initials: D
authors.lastname: Hallett
authors.affiliation: Division of Pulmonary/Critical Care Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Collop
authors.affiliation: Critical Care Program, Queen's University and Kingston General Hospital, Kingston, ON K7L1V9, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Drover
authors.affiliation: Intensive Care Unit, St Andrew's War Memorial Hospital, Brisbane 4000, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Lavercombe
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Brussels 1070, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Leeman
authors.affiliation: Kootenay Lake Hospital, Nelson, BC V1L2V1, Canada.
authors.forename: Shiraz
authors.initials: S
authors.lastname: Moola
authors.affiliation: Department Of Anaesthesiology, University of Witwatersrand, Johannesburg 2000, South Africa.
authors.forename: Fathima
authors.initials: F
authors.lastname: Paruk
authors.affiliation: Intensive Care Unit, Mount Sinai Hospital and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada M5G 1X5.
authors.forename: Michael
authors.initials: M
authors.lastname: Bernstein
authors.affiliation: King Edward VIII Hospital and Womens Health and HIV Research group, University of Kwa Zulu Natal, Durban 4013, South Africa.
authors.forename: Jack
authors.initials: J
authors.lastname: Moodley
mesh_terms: D018806:APACHE; D000328:Adult; D000704:Analysis of Variance; D002138:Calibration; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008991:Monitoring, Physiologic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality* / Q000503:physiopathology; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D055815:Young Adult