Maternal physiological parameters and routine laboratory tests to screen for maternal sepsis: an observational cohort study

IF 2.6 3区 医学 Q2 ANESTHESIOLOGY
T. Culling , C. Bertorelli , A. Strang , S. Oram , F. Faggian , S. Sharma , A. Ridgeway , Summia Zaher , Mario Labeta , Simon A. Jones , Luke C. Davies , John Watkins , Kate Siddall , Vikki Keeping , Kathryn Simpson , Maryanne Bray , Peter Ghazal , Sarah F. Bell , Rachel E. Collis
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引用次数: 0

Abstract

Background

Maternal sepsis can lead to poor outcomes for the mother and neonate, and early diagnosis and treatment of infection is important to prevent sepsis. Current guidance to recognise maternal sepsis includes assessment of physiological markers, however normal physiological changes of pregnancy can hinder the diagnosis of sepsis. This study investigated the utility of routine clinical variables, including laboratory tests, in screening for maternal sepsis.

Methods

Patients considered at risk of obstetric sepsis were recruited into a single centre cohort study. Microbiological, histological and clinical data categorised patients into three diagnostic groups: ‘infection confirmed’, ‘infection unknown’ and ‘infection unlikely’. Differences in physiological and routine laboratory variables were investigated.

Results

Between November 2020 and December 2022, 154 pregnant patients were recruited. Comparison between ‘infection confirmed’ (n=58) and ‘infection unlikely’ (n=17) showed statistical differences in temperature (P <0.001), neutrophil count (P =0.003) and leukocyte count (P =0.004) at the time of recruitment. Temperature was the best discriminator with an area under the receiver operating characteristic curve (AUC-ROC) of 0.82 (95% CI 0.70 to 0.94, P <0.0001) with an optimal threshold of ≥37.5°C.

Conclusion

This observational cohort study demonstrated that maternal temperature ≥37.5°C (rather than the threshold of 38°C found in most screening tools) may be important in screening patients at risk of developing maternal sepsis. When temperature ≥37.5°C persists, medical care should be expedited and maternal infection considered.
产妇生理参数和常规实验室检查筛查产妇败血症:一项观察性队列研究
母体败血症可导致母亲和新生儿预后不良,早期诊断和治疗感染对预防败血症非常重要。目前的指导,以认识产妇败血症包括评估生理标志物,然而正常的生理变化妊娠可阻碍败血症的诊断。本研究调查了常规临床变量,包括实验室检查,在筛选产妇败血症的效用。方法将有产科脓毒症风险的患者纳入单中心队列研究。微生物学、组织学和临床数据将患者分为三个诊断组:“确诊感染”、“感染未知”和“不太可能感染”。研究了生理和常规实验室变量的差异。结果在2020年11月至2022年12月期间,招募了154名孕妇。“确诊感染”(n=58)和“未确诊感染”(n=17)的比较显示,招募时的体温(P <0.001)、中性粒细胞计数(P =0.003)和白细胞计数(P =0.004)均有统计学差异。温度是最佳鉴别指标,受试者工作特征曲线下面积(AUC-ROC)为0.82 (95% CI 0.70 ~ 0.94, P <0.0001),最佳阈值≥37.5°C。结论本观察性队列研究表明,产妇体温≥37.5°C(而不是大多数筛查工具中发现的38°C阈值)可能对筛查有发生产妇脓毒症风险的患者很重要。当体温持续≥37.5℃时,应尽快就医并考虑母体感染。
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来源期刊
CiteScore
4.70
自引率
7.10%
发文量
285
审稿时长
58 days
期刊介绍: The International Journal of Obstetric Anesthesia is the only journal publishing original articles devoted exclusively to obstetric anesthesia and bringing together all three of its principal components; anesthesia care for operative delivery and the perioperative period, pain relief in labour and care of the critically ill obstetric patient. • Original research (both clinical and laboratory), short reports and case reports will be considered. • The journal also publishes invited review articles and debates on topical and controversial subjects in the area of obstetric anesthesia. • Articles on related topics such as perinatal physiology and pharmacology and all subjects of importance to obstetric anaesthetists/anesthesiologists are also welcome. The journal is peer-reviewed by international experts. Scholarship is stressed to include the focus on discovery, application of knowledge across fields, and informing the medical community. Through the peer-review process, we hope to attest to the quality of scholarships and guide the Journal to extend and transform knowledge in this important and expanding area.
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