The Continuum of Maternal Sepsis Severity: Incidence and Risk Factors in a Population-Based Cohort Study

被引:91
作者
Acosta, Colleen D. [1 ]
Knight, Marian [1 ]
Lee, Henry C. [2 ,3 ]
Kurinczuk, Jennifer J. [1 ]
Gould, Jeffrey B. [2 ,3 ,5 ]
Lyndon, Audrey [4 ,5 ]
机构
[1] Univ Oxford, Natl Perinatal Epidemiol Unit, Oxford, England
[2] Stanford Univ, Dept Pediat, Palo Alto, CA 94304 USA
[3] Calif Perinatal Qual Care Collaborat, Stanford, CA USA
[4] Univ Calif San Francisco, Dept Family Hlth Care Nursing, San Francisco, CA 94143 USA
[5] Calif Maternal Qual Care Collaborat, Stanford, CA USA
来源
PLOS ONE | 2013年 / 8卷 / 07期
基金
美国国家卫生研究院;
关键词
SEVERE OBSTETRIC MORBIDITY; PREGNANCY-RELATED MORTALITY; INTENSIVE-CARE UNITS; HOSPITAL VOLUME; PRENATAL-CARE; STATES; EPIDEMIOLOGY; INFECTION; LINKAGE;
D O I
10.1371/journal.pone.0067175
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Objective: To investigate the incidence and risk factors associated with uncomplicated maternal sepsis and progression to severe sepsis in a large population-based birth cohort. Methods: This retrospective cohort study used linked hospital discharge and vital statistics records data for 1,622,474 live births in California during 2005-2007. Demographic and clinical factors were adjusted using multivariable logistic regression with robust standard errors. Results: 1598 mothers developed sepsis; incidence of all sepsis was 10 per 10,000 live births (95% CI = 9.4-10.3). Women had significantly increased adjusted odds (aOR) of developing sepsis if they were older (25-34 years: aOR = 1.29; >= 35 years: aOR = 1.41), had <= high-school education (aOR = 1.63), public/no-insurance (aOR = 1.22) or a cesarean section (primary: aOR = 1.99; repeat: aOR = 1.25). 791 women progressed to severe sepsis; incidence of severe sepsis was 4.9 per 10,000 live births (95% CI = 4.5-5.2). Women had significantly increased adjusted odds of progressing to severe sepsis if they were Black (aOR = 2.09), Asian (aOR = 1.59), Hispanic (aOR = 1.42), had public/no-insurance (aOR = 1.52), delivered in hospitals with <1,000 births/year (aOR = 1.93), were primiparous (aOR = 2.03), had a multiple birth (aOR = 3.5), diabetes (aOR = 1.47), or chronic hypertension (aOR = 8.51). Preeclampsia and postpartum hemorrhage were also significantly associated with progression to severe sepsis (aOR = 3.72; aOR = 4.18). For every cumulative factor, risk of uncomplicated sepsis increased by 25% (95% CI = 17.4-32.3) and risk of progression to severe sepsis/septic shock increased by 57% (95% CI = 40.8-74.4). Conclusions: The rate of severe sepsis was approximately twice the 1991-2003 national estimate. Risk factors identified are relevant to obstetric practice given their cumulative risk effect and the apparent increase in severe sepsis incidence.
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页数:8
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