Validación de modelos de SCORE para el pronóstico de sepsis en pacientes obstétricas y sus desenlaces neonatales: estudio prospectivo multicéntrico en Colombia
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Fecha
2025
Autores
Cifuentes Trujillo, Sofia
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Ediciones Universidad Simón Bolívar
Facultad de Ciencias de la Salud
Facultad de Ciencias de la Salud
Resumen
Introducción: La sepsis obstétrica continúa siendo una causa importante de
morbilidad y mortalidad materna a nivel global, con mayor impacto en contextos de
baja y mediana renta. La detección precoz de desenlaces graves en estas pacientes
sigue siendo un desafío clínico, especialmente ante la ausencia de herramientas
diagnósticas validadas en poblaciones gestantes. Este estudio evalúa el
rendimiento de distintas escalas clínicas para predecir desenlaces maternos y
neonatales graves.
Objetivo: Validar y comparar el desempeño diagnóstico de las escalas SOFA,
omSOFA, qSOFA, SIRS y OEWS para la predicción de disfunción orgánica y
desenlaces maternos graves (SMO). en pacientes obstétricas con infección en
Colombia.
Métodos: Estudio prospectivo multicéntrico realizado en 12 centros hospitalarios de
tercer nivel. Se incluyeron 2.198 pacientes obstétricas con infección presunta o
confirmada. Se calcularon métricas diagnósticas (sensibilidad, especificidad, AUC,
odds ratio diagnóstico). para cada escala, y se evaluaron asociaciones con
desenlaces clínicos maternos y neonatales.
Resultados: La escala SOFA ≥ 2 obtuvo el mejor rendimiento global (AUC: 0,692;
DOR: 31,1), seguida por omSOFA (AUC: 0,663; DOR: 21,7). La puntuación qSOFA
≥ 2 mostró alta especificidad (97,2 %). pero sensibilidad limitada (14,9 %). La escala
OEWS en su umbral medio/alto presentó equilibrio aceptable entre sensibilidad
(47,3 %). y especificidad (89,9 %). El SMO ocurrió en el 6,73 % de las pacientes,
con una fuerte asociación con valores elevados de SOFA, omSOFA y OEWS.
Conclusión: SOFA y omSOFA demostraron ser las herramientas más precisas
para la identificación precoz de pacientes obstétricas con alto riesgo de desenlaces
graves. La integración de estas escalas en protocolos clínicos puede optimizar la
respuesta frente a la sepsis obstétrica. OEWS representa una opción útil para
vigilancia continua, mientras que qSOFA no debe utilizarse de forma aislada en esta
población.
Introduction: Obstetric sepsis remains a major contributor to maternal morbidity and mortality worldwide, particularly in low- and middle-income settings. Early identification of patients at risk of severe outcomes is hindered by the lack of validated diagnostic tools adapted to pregnancy. This study evaluates the performance of several clinical scoreing systems in predicting severe maternal and neonatal outcomes. Objective: To validate and compare the diagnostic performance of SOFA, omSOFA, qSOFA, SIRS, and OEWS scores in predicting organ dysfunction and severe maternal outcomes (SMO). in obstetric patients with infection in Colombia. Methods: A prospective multicenter observational study was conducted across 12 tertiary hospitals. A total of 2,198 pregnant or postpartum women with suspected or confirmed infections were included. Diagnostic metrics (sensitivity, specificity, AUC, diagnostic odds ratio). were calculated for each score, and associations with maternal and neonatal outcomes were analyzed. Results: SOFA ≥ 2 showed the highest overall performance (AUC: 0.692; DOR: 31.1), followed by omSOFA (AUC: 0.663; DOR: 21.7). qSOFA ≥ 2 demonstrated high specificity (97.2%). but low sensitivity (14.9%). OEWS at medium/high threshold provided a balanced profile (sensitivity: 47.3%; specificity: 89.9%). Severe maternal outcomes occurred in 6.73% of patients and were strongly associated with elevated SOFA, omSOFA, and OEWS scores. Neonatal adverse outcomes were also more frequent among cases with maternal dysfunction. Conclusion: SOFA and omSOFA are the most accurate tools for early identification of obstetric patients at risk of severe outcomes. Their integration into clinical sepsis protocols may improve maternal care and survival. OEWS can support continuous monitoring in non-critical settings, while qSOFA should not be used as a standalone screening tool in obstetric populations.
Introduction: Obstetric sepsis remains a major contributor to maternal morbidity and mortality worldwide, particularly in low- and middle-income settings. Early identification of patients at risk of severe outcomes is hindered by the lack of validated diagnostic tools adapted to pregnancy. This study evaluates the performance of several clinical scoreing systems in predicting severe maternal and neonatal outcomes. Objective: To validate and compare the diagnostic performance of SOFA, omSOFA, qSOFA, SIRS, and OEWS scores in predicting organ dysfunction and severe maternal outcomes (SMO). in obstetric patients with infection in Colombia. Methods: A prospective multicenter observational study was conducted across 12 tertiary hospitals. A total of 2,198 pregnant or postpartum women with suspected or confirmed infections were included. Diagnostic metrics (sensitivity, specificity, AUC, diagnostic odds ratio). were calculated for each score, and associations with maternal and neonatal outcomes were analyzed. Results: SOFA ≥ 2 showed the highest overall performance (AUC: 0.692; DOR: 31.1), followed by omSOFA (AUC: 0.663; DOR: 21.7). qSOFA ≥ 2 demonstrated high specificity (97.2%). but low sensitivity (14.9%). OEWS at medium/high threshold provided a balanced profile (sensitivity: 47.3%; specificity: 89.9%). Severe maternal outcomes occurred in 6.73% of patients and were strongly associated with elevated SOFA, omSOFA, and OEWS scores. Neonatal adverse outcomes were also more frequent among cases with maternal dysfunction. Conclusion: SOFA and omSOFA are the most accurate tools for early identification of obstetric patients at risk of severe outcomes. Their integration into clinical sepsis protocols may improve maternal care and survival. OEWS can support continuous monitoring in non-critical settings, while qSOFA should not be used as a standalone screening tool in obstetric populations.
Descripción
Palabras clave
Sepsis obstétrica, Morbilidad materna grave, Escalas de gravedad clínica, SOFA, omSOFA, Sistema de alerta temprana obstétrica (OEWS), Desenlace materno-neonatal.
