Characterization of obstetric patients with multiple organ failure in the intensive care unit of a Havana teaching hospital, 1998 to 2006.

INTRODUCTION: Most obstetric patients admitted to intensive care units (ICU) present life-threatening complications of pregnancy, delivery, and postpartum, often leading to multiple organ failure (MOF), considered the main cause of death in ICUs. Although maternal mortality is an important indicator of health status in women and nations, few studies have analyzed MOF in obstetric ICU patients. The Sequential Organ Failure Assessment (SOFA) scale is a prognostic tool for ranking organ dysfunction in critically ill patients and correlating scores with outcome.

OBJECTIVE: Characterize obstetric patients diagnosed with MOF in the ICU of the Enrique Cabrera General Teaching Hospital, Havana, Cuba, between January 1, 1998 and December 31, 2006.

METHODS: A descriptive observational study was conducted of obstetric patients admitted to the ICU for >24 hours during the study period and diagnosed with MOF. Of 422 obstetric patients admitted, 58 met inclusion criteria. Patients' clinical characteristics, chronic diseases, diagnoses, Acute Physiology and Chronic Health Evaluation (APACHE II) scores, SOFA scores and discharge status were recorded in a data collection form. Day 1, Day 3, and maximum APACHE II and SOFA scores were calculated, and 3 prognostic groups were formed based on the difference between SOFA Day 1 and Day 3 scores (SOFAd 3-1: <0, clinical improvement; =0, no change; >0, poor prognosis). Data was entered in an EXCEL database and processed using SPSS 13.0 software. Quantitative variables were described by mean and standard deviation; qualitative variables by totals and percentages. A chi-square test was used to analyze associations between these variables and discharge status (alive or deceased) with significance level p <0.05.

RESULTS: Mortality from MOF in the study sample was 50.0%. More patients died in the 30-34 year age group (9/16, 56.3%), but mortality was highest in the 15-19 year age group (5/6, 83.3%) and was significantly associated with presence of preexisting chronic diseases (63.3% mortality in those patients). Postpartum hemorrhage was the most frequent obstetric condition (32.8% of cases), followed by preeclampsia (8.6%). Sickle cell anemia was the most frequent non-obstetric condition (15.5% of cases), followed by acute peritonitis (12.1% of cases). A <0 SOFAd 3-1 score correlated with a favorable prognosis (5.6% mortality) and a >0 score with an unfavorable prognosis (84.0% mortality). Respiratory and cardiovascular systems were the most affected (75.9% each).

CONCLUSIONS: Further studies analyzing MOF in obstetric patients are urgently needed in order to adopt more effective strategies for reducing maternal mortality in Cuba.