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The continuum of maternal sepsis severity: incidence and risk factors in a population-based cohort study.

CPQCC Publication
TitleThe continuum of maternal sepsis severity: incidence and risk factors in a population-based cohort study.
Publication TypeJournal Article
Year of Publication2013
AuthorsAcosta CD, Knight M, Lee HC, Kurinczuk JJ, Gould JB, Lyndon A
JournalPLoS One
Date Published2013
KeywordsAdult, African Continental Ancestry Group, Age Factors, California, Cohort Studies, Disease Progression, European Continental Ancestry Group, Female, Hispanic Americans, Humans, Incidence, Logistic Models, Maternal Age, Parity, Pregnancy, Pregnancy Complications, Infectious, Risk Factors, Sepsis, Severity of Illness Index

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.

Alternate JournalPLoS ONE
PubMed ID23843991
PubMed Central IDPMC3699572
Grant ListKL2 RR024130 / RR / NCRR NIH HHS / United States
RP-PG-0608-10038 / / Department of Health / United Kingdom
KL2TR000143 / TR / NCATS NIH HHS / United States