High Mortality Rate of Obstetric Critically ILL Patients in Rwanda and Its Predictability

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Abstract BackgroundReasons for obstetric admission in intensive care unit (ICU) vary from a setting to another. Outcomes from ICU and its prediction models are not well explored in Rwanda because of lack of appropriate scores. This study intended to assess profile and accuracy of predictive models for obstetric patients admitted in ICU in the two public tertiary hospitals in Rwanda.MethodsWe prospectively collected data from all obstetric patients admitted in the ICU of public referral hospitals in Rwanda from March 2017 to February 2018 to identify reasons for admissions and factors for prognosis. We analysed the accuracy of mortality prediction by the quick Sequential Organ Failure Assessment (qSOFA) and Modified Early Obstetric Warning Score (MEOWS). ResultsObstetric patients represented 12.8% of all ICU admissions and 1.8% of all deliveries. Sepsis (31.9%) and haemorrhage (25.5%) were the two commonest reasons of admission. Mortality was 54.3% while the average length of stay was 6.6 days. MEOWS was an independent predictor to mortality (adjusted OR=1.25[1.07-1.46]; p=0.005). Similarly, one point of increase of the qSOFA increased odds of ICU mortality by 181% (adjusted OR=2.81[1.25-6.30]; p=0.012). The Area Under the Receiver Operating Characteristic Curve (AUROC) for MEOWS was 0.773[0.666-0.880], p=0.0001 and that of the qSOFA was 0.764[0.654-0.873]; p=0.0001.ConclusionSepsis is the most common reason for obstetric admissions to ICU in Rwanda. MEOWS and qSOFA could accurately predict the mortality for those patients but further explorations on a larger sample size are guaranteed.

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