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Critical Care |

Predictors of Development of Pregnancy-Associated Severe Sepsis and Its Associated Mortality: A Population-Based Study

Lavi Oud, MD; Phillip Watkins, MS; Moss Hampton, MD
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Texas Tech University HSC, Odessa, TX


Chest. 2013;144(4_MeetingAbstracts):417A. doi:10.1378/chest.1700921
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Abstract

SESSION TITLE: Sepsis and Shock Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Only limited data were reported to date on the contemporary epidemiology of pregnancy-associated severe sepsis (PASS), focusing mostly on delivery hospitalizations. We performed a population-based investigation of the risk factors for development of PASS and its associated mortality among Texas residents over the past decade.

METHODS: We used the Texas Inpatient Public Use Data File to identify pregnancy-associated hospitalizations for the years 2001-2010. ICD-9CM codes for infection plus organ failure were used to identify PASS hospitalizations. Candidate demographic and clinical predictors of PASS and PASS-associated hospital mortality were examined. Univariate analysis, followed by multivariate logistic regression modeling were performed.

RESULTS: There were 4,060,201 pregnancy-associated hospitalizations, 1007 PASS hospitalizations, and 111 PASS-associated deaths during study period. Delivery hospitalizations accounted for 38% of all PASS hospitalizations. The following key risk factors were independently associated (OR [IQR]) with PASS: chronic liver disease (47.3 [36.3-61.7]), congestive heart failure (CHF) (18.9 [14.3-25.2]), gestational diabetes (GDM) (6.9 [3.9-12.2]), anemia (5.6 [4.8-6.4]), drug abuse (2.9 [2.2-4.1]), lack of health insurance [vs. private insurance] (1.4 [1.1-1.8]), black race (1.3 [1.1-1.5]), and age ≥35 (1.2 [1.01-1.4]). Major predictors of PASS-associated mortality were: GDM (3.9 [1.1-13.5]), drug abuse (3.3 [1.4-7.8]), lack of health insurance (3.1 [1.4-6.9]), septic shock (1.9 [1.2-3.2]), and age ≥35 (1.9 [1.1-3.4]).

CONCLUSIONS: The present cohort of PASS is the largest described to date. Chronic liver, CHF, GDM, anemia, drug abuse, and selected demographics were most strongly associated with development of PASS. The risk of PASS-associated death was highest with GDM, drug abuse and an uninsured state, nearly doubling with septic shock. Focus on delivery hospitalizations underestimates the burden of PASS and associated maternal mortality. The identified risk groups merit further study to limit occurrence of PASS and its associated mortality.

CLINICAL IMPLICATIONS: Chronic liver disease and CHF pose especially high risk of PASS. Pregnant women with GDM , drug abuse, increased age and lacking health insurance are at high risk of both developing and dying with PASS, requiring extra vigilance for early diagnosis and targeted intervention.

DISCLOSURE: The following authors have nothing to disclose: Lavi Oud, Phillip Watkins, Moss Hampton

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