Sepsis in Obstetrics Score (SOS) utility and validation for triaging patients with obstetric sepsis in the emergency department: Evidence from a low income health care setting

Abstract

Background Illness severity scores commonly used in critical care settings are not considered appropriate in obstetric practice as they do not account for pregnancy physiology. A new illness severity score called the ‘Sepsis in Obstetrics Score’ (SOS) was introduced by Albright et al. for triaging patients with sepsis in pregnancy in an emergency department setting. Objectives We aimed to determine whether this score could predict the need for critical care support using the presence of organ failure as the identification criteria. Severity and culture positivity in pregnancy-associated sepsis was also assessed. Materials and methods All pregnant, postabortal and postpartum women with suspected sepsis were enrolled (as per systemic inflammatory response syndrome criteria) were enrolled. Severe pregnancy-associated sepsis was defined as dysfunction of one or more organs due to sepsis. The severity of pregnancy-associated sepsis was graded according to the number of organ failures. A SOS cut off of 6 was taken for statistical analysis. Results Out of 100 women with pregnancy-associated sepsis, ‘severe sepsis’ was present in 58%. When the SOS test performance was compared with the severity of pregnancy-associated sepsis, it had sensitivity of 68.9% and specificity of 80.9%, positive predictive value of 83% and negative predictive value 65% to predict severe sepsis. The area under curve for the SOS detecting severe pregnancy-associated sepsis was 0.810. SOS predicted organ failure in pregnancy-associated sepsis and this was statistically significant for all organs involved. Culture positivity did not correlate with the SOS in our study. Conclusions Sepsis in Obstetrics Score correlated well with organ failure in pregnancy-associated sepsis. It had a high positive predictive value (83%) for severe sepsis.