The Continuum of Maternal Sepsis Severity: Incidence and Risk Factors in a Population-Based Cohort Study
被引:91
作者:
Acosta, Colleen D.
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机构:
Univ Oxford, Natl Perinatal Epidemiol Unit, Oxford, EnglandUniv Oxford, Natl Perinatal Epidemiol Unit, Oxford, England
Acosta, Colleen D.
[1
]
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Knight, Marian
[1
]
Lee, Henry C.
论文数: 0引用数: 0
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机构:
Stanford Univ, Dept Pediat, Palo Alto, CA 94304 USA
Calif Perinatal Qual Care Collaborat, Stanford, CA USAUniv Oxford, Natl Perinatal Epidemiol Unit, Oxford, England
Lee, Henry C.
[2
,3
]
Kurinczuk, Jennifer J.
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机构:
Univ Oxford, Natl Perinatal Epidemiol Unit, Oxford, EnglandUniv Oxford, Natl Perinatal Epidemiol Unit, Oxford, England
Kurinczuk, Jennifer J.
[1
]
Gould, Jeffrey B.
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h-index: 0
机构:
Stanford Univ, Dept Pediat, Palo Alto, CA 94304 USA
Calif Perinatal Qual Care Collaborat, Stanford, CA USA
Calif Maternal Qual Care Collaborat, Stanford, CA USAUniv Oxford, Natl Perinatal Epidemiol Unit, Oxford, England
Gould, Jeffrey B.
[2
,3
,5
]
Lyndon, Audrey
论文数: 0引用数: 0
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机构:
Univ Calif San Francisco, Dept Family Hlth Care Nursing, San Francisco, CA 94143 USA
Calif Maternal Qual Care Collaborat, Stanford, CA USAUniv Oxford, Natl Perinatal Epidemiol Unit, Oxford, England
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
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.
机构:
Dept Vet Affairs Med Ctr, Vet Affairs Outcomes Grp 111B, White River Jct, VT 05009 USADept Vet Affairs Med Ctr, Vet Affairs Outcomes Grp 111B, White River Jct, VT 05009 USA
Birkmeyer, JD
Siewers, AE
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机构:Dept Vet Affairs Med Ctr, Vet Affairs Outcomes Grp 111B, White River Jct, VT 05009 USA
Siewers, AE
Finlayson, EVA
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h-index: 0
机构:Dept Vet Affairs Med Ctr, Vet Affairs Outcomes Grp 111B, White River Jct, VT 05009 USA
Finlayson, EVA
Stukel, TA
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h-index: 0
机构:Dept Vet Affairs Med Ctr, Vet Affairs Outcomes Grp 111B, White River Jct, VT 05009 USA
Stukel, TA
Lucas, FL
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机构:Dept Vet Affairs Med Ctr, Vet Affairs Outcomes Grp 111B, White River Jct, VT 05009 USA
Lucas, FL
Batista, I
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机构:Dept Vet Affairs Med Ctr, Vet Affairs Outcomes Grp 111B, White River Jct, VT 05009 USA
Batista, I
Welch, HG
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h-index: 0
机构:Dept Vet Affairs Med Ctr, Vet Affairs Outcomes Grp 111B, White River Jct, VT 05009 USA
Welch, HG
Wennberg, DE
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h-index: 0
机构:Dept Vet Affairs Med Ctr, Vet Affairs Outcomes Grp 111B, White River Jct, VT 05009 USA
机构:
Univ Calif San Francisco, Dept Obstet Gynecol & Reprod Sci, San Francisco, CA 94143 USAUniv Calif San Francisco, Dept Obstet Gynecol & Reprod Sci, San Francisco, CA 94143 USA
Bryant, Allison S.
Worjoloh, Ayaba
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h-index: 0
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Univ Calif San Francisco, Dept Obstet Gynecol & Reprod Sci, San Francisco, CA 94143 USAUniv Calif San Francisco, Dept Obstet Gynecol & Reprod Sci, San Francisco, CA 94143 USA
Worjoloh, Ayaba
Caughey, Aaron B.
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Univ Calif San Francisco, Dept Obstet Gynecol & Reprod Sci, San Francisco, CA 94143 USAUniv Calif San Francisco, Dept Obstet Gynecol & Reprod Sci, San Francisco, CA 94143 USA
Caughey, Aaron B.
Washington, A. Eugene
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Univ Calif San Francisco, Dept Obstet Gynecol & Reprod Sci, San Francisco, CA 94143 USAUniv Calif San Francisco, Dept Obstet Gynecol & Reprod Sci, San Francisco, CA 94143 USA
机构:
Univ Med & Dent New Jersey, Robert Wood Johnson Med Sch, Dept Med, Div Pulm & Crit Care Med, New Brunswick, NJ 08903 USAUniv Med & Dent New Jersey, Robert Wood Johnson Med Sch, Dept Med, Div Pulm & Crit Care Med, New Brunswick, NJ 08903 USA
Dombrovskiy, Viktor Y.
Martin, Andrew A.
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机构:Univ Med & Dent New Jersey, Robert Wood Johnson Med Sch, Dept Med, Div Pulm & Crit Care Med, New Brunswick, NJ 08903 USA
Martin, Andrew A.
Sunderram, Jagadeeshan
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机构:Univ Med & Dent New Jersey, Robert Wood Johnson Med Sch, Dept Med, Div Pulm & Crit Care Med, New Brunswick, NJ 08903 USA
Sunderram, Jagadeeshan
Paz, Harold L.
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h-index: 0
机构:Univ Med & Dent New Jersey, Robert Wood Johnson Med Sch, Dept Med, Div Pulm & Crit Care Med, New Brunswick, NJ 08903 USA
机构:
Dept Vet Affairs Med Ctr, Vet Affairs Outcomes Grp 111B, White River Jct, VT 05009 USADept Vet Affairs Med Ctr, Vet Affairs Outcomes Grp 111B, White River Jct, VT 05009 USA
Birkmeyer, JD
Siewers, AE
论文数: 0引用数: 0
h-index: 0
机构:Dept Vet Affairs Med Ctr, Vet Affairs Outcomes Grp 111B, White River Jct, VT 05009 USA
Siewers, AE
Finlayson, EVA
论文数: 0引用数: 0
h-index: 0
机构:Dept Vet Affairs Med Ctr, Vet Affairs Outcomes Grp 111B, White River Jct, VT 05009 USA
Finlayson, EVA
Stukel, TA
论文数: 0引用数: 0
h-index: 0
机构:Dept Vet Affairs Med Ctr, Vet Affairs Outcomes Grp 111B, White River Jct, VT 05009 USA
Stukel, TA
Lucas, FL
论文数: 0引用数: 0
h-index: 0
机构:Dept Vet Affairs Med Ctr, Vet Affairs Outcomes Grp 111B, White River Jct, VT 05009 USA
Lucas, FL
Batista, I
论文数: 0引用数: 0
h-index: 0
机构:Dept Vet Affairs Med Ctr, Vet Affairs Outcomes Grp 111B, White River Jct, VT 05009 USA
Batista, I
Welch, HG
论文数: 0引用数: 0
h-index: 0
机构:Dept Vet Affairs Med Ctr, Vet Affairs Outcomes Grp 111B, White River Jct, VT 05009 USA
Welch, HG
Wennberg, DE
论文数: 0引用数: 0
h-index: 0
机构:Dept Vet Affairs Med Ctr, Vet Affairs Outcomes Grp 111B, White River Jct, VT 05009 USA
机构:
Univ Calif San Francisco, Dept Obstet Gynecol & Reprod Sci, San Francisco, CA 94143 USAUniv Calif San Francisco, Dept Obstet Gynecol & Reprod Sci, San Francisco, CA 94143 USA
Bryant, Allison S.
Worjoloh, Ayaba
论文数: 0引用数: 0
h-index: 0
机构:
Univ Calif San Francisco, Dept Obstet Gynecol & Reprod Sci, San Francisco, CA 94143 USAUniv Calif San Francisco, Dept Obstet Gynecol & Reprod Sci, San Francisco, CA 94143 USA
Worjoloh, Ayaba
Caughey, Aaron B.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Calif San Francisco, Dept Obstet Gynecol & Reprod Sci, San Francisco, CA 94143 USAUniv Calif San Francisco, Dept Obstet Gynecol & Reprod Sci, San Francisco, CA 94143 USA
Caughey, Aaron B.
Washington, A. Eugene
论文数: 0引用数: 0
h-index: 0
机构:
Univ Calif San Francisco, Dept Obstet Gynecol & Reprod Sci, San Francisco, CA 94143 USAUniv Calif San Francisco, Dept Obstet Gynecol & Reprod Sci, San Francisco, CA 94143 USA
机构:
Univ Med & Dent New Jersey, Robert Wood Johnson Med Sch, Dept Med, Div Pulm & Crit Care Med, New Brunswick, NJ 08903 USAUniv Med & Dent New Jersey, Robert Wood Johnson Med Sch, Dept Med, Div Pulm & Crit Care Med, New Brunswick, NJ 08903 USA
Dombrovskiy, Viktor Y.
Martin, Andrew A.
论文数: 0引用数: 0
h-index: 0
机构:Univ Med & Dent New Jersey, Robert Wood Johnson Med Sch, Dept Med, Div Pulm & Crit Care Med, New Brunswick, NJ 08903 USA
Martin, Andrew A.
Sunderram, Jagadeeshan
论文数: 0引用数: 0
h-index: 0
机构:Univ Med & Dent New Jersey, Robert Wood Johnson Med Sch, Dept Med, Div Pulm & Crit Care Med, New Brunswick, NJ 08903 USA
Sunderram, Jagadeeshan
Paz, Harold L.
论文数: 0引用数: 0
h-index: 0
机构:Univ Med & Dent New Jersey, Robert Wood Johnson Med Sch, Dept Med, Div Pulm & Crit Care Med, New Brunswick, NJ 08903 USA