title: Mortality risk prediction with an updated Acute Physiology and Chronic Health Evaluation II score in critically ill obstetric patients: a cohort study.
abstract: BACKGROUND
  Acute Physiology and Chronic Health Evaluation II (APACHE II) score has shown low prognostic ability to predict death in the obstetric population. The objective of this study was to evaluate whether an updated form of the APACHE II score would perform better in predicting mortality in critically ill obstetric patients.
  
  
  METHODS
  A retrospective cohort study of pregnant and postpartum women (up to 42 days after delivery) who were admitted to the intensive care unit (ICU) was carried out at an ICU at Rafael Calvo Maternity Hospital, a large obstetric hospital in Colombia. Data were collected on consecutive obstetric patients admitted to the ICU between 2006 and 2011. A discrimination and calibration analysis was completed on the original APACHE II score and an updated APACHE II score.
  
  
  RESULTS
  Data were collected on a total of 726 obstetric patients. The area under the receiver-operating characteristic curve was 0.86 (95% confidence interval [95% CI], 0.80-0.93) for both APACHE II and the updated APACHE II scores. Mortality ratio for the original APACHE II was 0.30 (95% CI, 0.19-0.41) and 0.85 (95% CI, 0.56-1.24) for the updated APACHE II.
  
  
  CONCLUSIONS
  The APACHE II overestimates mortality in the sample population. The updated APACHE II model predicts mortality more accurately in the obstetric population. This formula may be useful in adapting the existing APACHE II to current mortality risk in obstetric critical care populations.
authors.affiliation: Grupo de Investigación en Cuidados intensivos y Obstetricia, GRICIO, Universidad de Cartagena, Cartagena, Colombia angel.paternina@gmail.com.
authors.forename: Angel J
authors.initials: AJ
authors.lastname: Paternina-Caicedo
authors.affiliation: Grupo de Investigación en Cuidados intensivos y Obstetricia, GRICIO, Universidad de Cartagena, Cartagena, Colombia Unidad de Cuidados Intensivos, Gestion Salud S.A. at Clinica Maternidad Rafael Calvo, Cartagena, Colombia.
authors.forename: José A
authors.initials: JA
authors.lastname: Rojas-Suarez
authors.affiliation: Grupo de Investigación en Cuidados intensivos y Obstetricia, GRICIO, Universidad de Cartagena, Cartagena, Colombia Unidad de Cuidados Intensivos, Gestion Salud S.A. at Clinica Maternidad Rafael Calvo, Cartagena, Colombia.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Dueñas-Castel
authors.affiliation: Grupo de Investigación en Cuidados intensivos y Obstetricia, GRICIO, Universidad de Cartagena, Cartagena, Colombia.
authors.forename: Jezid E
authors.initials: JE
authors.lastname: Miranda-Quintero
authors.affiliation: Department of Medicine, Pulmonary and Critical Care Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Ghada
authors.initials: G
authors.lastname: Bourjeily
mesh_terms: D018806:APACHE; D000328:Adult; D015331:Cohort Studies; D003105:Colombia / Q000453:epidemiology; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008428:Maternal Mortality; D058725:Peripartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis
keywords: APACHE; critical care; high risk; mortality; pregnancy; pregnancy outcome; severity scores