Association of Kaiser sepsis score with confirmed intrauterine infection and inflammation (Triple-I) in clinical chorioamnionitis: a retrospective cohort study.

Abstract

Background: Chorioamnionitis is a known independent risk factor for early-onset sepsis (EOS) in infants. In 2015, the term was redefined as "intrauterine inflammation or infection or both" (Triple-I) to improve clinical management of maternal and neonatal infections. This study evaluated the association between the Kaiser sepsis score (KSS), a tool for predicting and managing EOS in newborns, and histopathologic chorioamnionitis (HCA) and confirmed Triple-I.

Methods: This retrospective cohort study included mother-infant dyads with a gestational age of ≥ 34 weeks at birth, delivered between January 2014 and December 2019, with a maternal diagnosis of clinical chorioamnionitis. Receiver operating characteristic (ROC) curves were used to assess the association between the KSS, Triple-I, and HCA.

Results: A total of 230 mother-infant dyads were analyzed, of whom 157 (68.2%) had HCA and 86 (37.3%) had confirmed Triple-I. Infant demographic characteristics were comparable between groups, except for the KSS, which was significantly higher in the Triple-I group [1.22 vs. 0.83, p < 0.001; OR 1.21, 95% CI 1.04-1.4]. The KSS demonstrated a strong positive association with confirmed Triple-I (AUC 0.77, 95% CI 0.71-0.83), while its association with HCA was weaker (AUC 0.59, 95% CI 0.51-0.67). At the same KSS threshold, sensitivity for diagnosing Triple-I was higher than for HCA.

Conclusion: KSS showed a stronger association with confirmed Triple-I compared to HCA in mothers with clinical chorioamnionitis, suggesting that Triple-I is a better predictor of EOS risk.