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obstetric bleeding&#41;&#59; or b&#41; indirect obstetric morbidity associated with preexisting conditions before pregnancy or during pregnancy&#44; not due to any obstetric causes&#44; but aggravated by the physiological effects of pregnancy &#40;eg&#44; valvular heart disease&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A total of 830 women die every day across the world due to pregnancy related causes&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> From 2014 to 2016 the United Kingdom reported a total of 259 MDs &#40;9&#46;8 women for every 100 000 live births &#40;LBs&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The United States reported a total of 18 MDs&#47;100 000 LBs&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> For every MD there are 118 cases of SMM<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and between 0&#46;5&#37; and 1&#46;3&#37; of pregnancies will be associated with SMM&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Inappropriate therapies&#44; delayed diagnoses&#44; and referral to a special care level contribute to maternal mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Between 55&#37; and 70&#37; of the cases of MD received suboptimal medical care&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> That is why the target established by the WHO is to reduce the overall MD rate to &#60; 70&#47;100 000 LBs&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The United Kingdom will try to cut the number of MD in half by 2025&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">On the other hand&#44; a prognostic model is the combination of multiple predictors to assess the risk of a specific outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> These models are useful to characterize the severity of the disease in clinical trials and assess the performance of ICUs&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Their validity &#40;capacity to predict a specific result&#41; includes&#58; a&#41; the discrimination or capacity to distinguish different individuals based on their different outcomes&#44; and b&#41; calibration or match between the probabilities observed and the probabilities anticipated of an occurring event&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Prognostic models in obstetric patients are not accurate because&#58; 1&#41; we are talking about young female patients with few comorbidities&#59; 2&#41; many obstetric complications improve significantly after pregnancy&#44; and 3&#41; due to the normal physiological changes of pregnancy&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> The Acute Physiology and Chronic Health Evaluation II &#40;APACHE II&#41; is the predictive model most commonly used at the ICU setting&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> However&#44; 5 of its variables have different reference values during pregnancy &#40;arterial blood pressure&#44; heart rate&#44; hematocrit&#44; creatinine and leukocyte levels&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;13</span></a> and it also overestimates the mortality rate&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The Sequential Organ Failure Assessment &#40;SOFA&#41; score assesses the degree of organ dysfunction and is less affected by the physiological changes of pregnancy&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Prognostic models can be improved by altering their equations or changing their variables&#44; a process known as personalization or recalibration<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Blanco et al&#46; propose an obstetric SOFA &#40;O-SOFA&#41; created from 2 modifications of the SOFA model &#40;Appendix B supplementary data 1&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and Paternina et al&#46; propose a modified APACHE II score &#40;APACHE II-M&#41; by changing the mathematical equation of the original APACHE II to better serve its validity among the obstetric population &#40;Appendix B supplementary data 1&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The objective of this study was to compare the validity of the APACHE II&#44; the APACHE II-M&#44; the SOFA&#44; and the O-SOFA to predict mortality in a cohort of patients with SMM who were admitted to our ICU&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Patients and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">Retrospective&#44; cohort study conducted at the ICU of the IMSS High Specialty Medical Unit 25 of Monterrey&#44; Nuevo Le&#243;n&#44; Mexico&#46; It was approved back on November 27&#44; 2018 by the Health Research Local Committee 1901with registry &#35;R-2018-1901-105&#46; It recruited patients from December 2015 through July 2018&#46; According to Peduzzi formula<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a><span class="elsevierStyleItalic">n&#8239;&#61;&#8239;&#40;TDF&#8239;&#215;&#8239;EPV&#47;LP&#41;</span><a class="elsevierStyleCrossRef" href="#fn0005"><span class="elsevierStyleSup">1</span></a> a minimum of 131 patients are needed for the analysis to be statistically significant&#46; The study used a convenience sampling method&#46; Only women who met the definition of SMM were included &#40;pregnant women or within the first 42 days since full-term pregnancy admitted to the ICU&#41;&#46; Women without enough information on the health records to assess their prognostic scales at the ICU admission were excluded&#46; In case of ICU readmission during the same hospitalization only the data from the first admission were included&#46; Patients were followed during hospitalization until their death or admission&#46; The patients&#8217; demographic data &#40;age&#44; number of pregnancies&#44; deliveries&#44; c-sections&#44; miscarriages&#44; gestational age&#44; and comorbidities&#41;&#44; main diagnosis at admission&#44; time elapsed since the beginning of the complication until admission to our unit&#44; and the variables needed to estimate the APACHE II&#44; APACHE II-M&#44; SOFA&#44; and O-SOFA scores were included&#46; Also&#44; clinical data on the patients&#8217; clinical progression such as the use of mechanical ventilation&#44; vasopressors&#44; renal replacement therapy&#44; and days at the ICU were included too&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Demographic data were documented with descriptive statistics using measures of central tendency and dispersion&#58; mean and standard deviation were used to expressed variables with normal distribution&#59; median and interquartile range were used to expressed variables without a normal distribution&#46; The inferential analysis was conducted using the Student <span class="elsevierStyleItalic">t</span>-test for independent samples or the Mann-Whitney <span class="elsevierStyleItalic">U</span> test for quantitative variables based on their normal distribution&#46; The chi-square test or Fisher&#8217;s exact test were used for the qualitative variables&#46; The degree of discrimination of every prognostic model was estimated using the area under the curve &#40;AUC&#41; of the receiver operating characteristics &#40;ROC&#41; and their 95&#37; confidence intervals &#40;95&#37;CI&#41;&#46; Calibration was estimated using the standard mortality ratio &#40;the ratio between the deaths seen and the deaths estimated&#41; and Hosmer-Lemeshow test for goodness of fit&#46; Sensitivity&#44; specificity&#44; positive predictive value &#40;PPV&#41;&#44; and negative predictive value &#40;NPV&#41; of every prognostic score was estimated as well&#46; The SPSS v 20&#46;0 software was used for statistical analysis&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">During the 56-month follow-up&#44; 6&#46;7&#37; of ICU admissions were obstetric patients &#40;143 admissions due to SMM&#41; all of them referred from other hospitals&#46; Two patients were excluded due to insufficient information to estimate some of the prognostic scales at admission&#46; The final analysis &#40;141 patients&#41; included 99 women in the pregnancy-puerperium period &#40;70&#46;3&#37;&#41; and 42 pregnant women &#40;29&#46;7&#37;&#41;&#46; A total of 62&#46;5&#37; of women in the pregnancy-puerperium period and 45&#37; of pregnant women had their complications in the third trimester&#46; Data on the clinical characteristics&#44; prognostic scores&#44; and disease progression are shown on <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Most admissions &#40;54&#46;6&#37;&#41; were due to indirect obstetric morbidity with an average time of 3&#46;1&#8239;&#177;&#8239;2&#46;5 days since the beginning of the complication until ICU admission&#46; The main causes of indirect obstetric morbidity were oncological-hematological &#40;Appendix B supplementary data 2&#41;&#46; The most common diagnosis at admission was pregnancy-induced hypertensive disease &#40;50 cases&#41;&#46; A total of 23 cases &#40;16&#46;3&#37;&#41; were classified as HELLP syndrome&#44; 19 &#40;13&#46;4&#37;&#41; as severe preeclampsia&#44; and 8 &#40;5&#46;6&#37;&#41; as eclampsia&#46; Diagnoses at admission and lethality are shown on <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; There were significant differences in the use of mechanical ventilation&#44; vasopressors&#44; and inotropic drugs between survivors and non-survivors&#46; However&#44; no differences were seen in the use of renal replacement therapy and days on intensive therapy &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The 4 prognostic scales were associated with the use of mechanical ventilation&#44; vasopressors&#44; renal replacement therapy&#44; and days at the ICU &#40;Appendix B supplementary data 2&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The characteristics of how the scores performed are shown on <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; In our cohort&#44; the rate of MD was 7&#37; and the 4 scales discriminated between survivors and non-survivors&#46; The largest ACU-ROC of all was that of the APACHE II and the APACHE II-M models &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; although this difference was not statistically significant &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;105&#41;&#46; All prognostic scales had low PPVs and high NPVs&#46; The 4 scales lost their statistical significance when they assessed pregnant patients and septic patients separately &#40;Appendix B supplementary data 2&#41;&#46; Based on the mortality ratio&#44; the APACHE II-M model predicted a lower number of deaths than observed&#46; The remaining models overestimated the risk&#46; In the Hosmer-Lemeshow logistic regression model the mortality prediction of both the APACHE II and the O-SOFA model were significantly different compared to the number of deaths reported &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">The 4 models analyzed showed discrimination capabilities&#46; Regarding calibration&#44; both the APACHE II-M and the SOFA models confirmed their superiority&#46; The patients&#8217; age of the non-survivors group &#40;32&#46;8&#8239;&#177;&#8239;15&#46;7 years&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;043&#41; was older compared to the survivors group&#46; Consistent with the MBRRACE-UK report that described a higher risk of MD with age &#40;7&#47;100 000 in the group of 20-to-24 year-old patients&#41;&#44; this risk duplicated to 14&#47;100 000 in women between 35 and 39 years-old&#44; and tripled to 22&#47;100 000 in women &#62; 40&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In this cohort&#44; indirect obstetric morbidity was more common &#40;54&#46;6&#37;&#41; including neurological&#44; oncological&#44; septic processes&#44; and acute pancreatitis in order of frequency&#46; Regarding direct obstetric morbidity&#44; pregnancy-induced hypertensive complications &#40;35&#37;&#41; and obstetric bleeding &#40;5&#46;6&#37;&#41; were the main diagnoses&#46; On the contrary in the cohort of the study conducted by Rojas et al&#46;&#44; admissions due to pregnancy-induced hypertensive disease and obstetric bleeding were predominant&#46; Also&#44; these were the 2 main causes of death&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> This difference can be explained by the fact that the ICU of the study conducted by Rojas is obstetric unlike our ICU &#40;polyvalent&#41;&#46; In our cohort&#44; the main cause of MD was pregnancy-induced hypertensive disease &#40;30&#37;&#41; followed by cardiovascular diseases &#40;20&#37;&#41; and neurological conditions &#40;20&#37;&#41;&#46; This contrasts with the data from the United Kingdom where 56&#46;4&#37; of all MDs were due to indirect causes such as heart disease and the causes of direct MD &#40;43&#46;5&#37; of the cases&#41;&#46; Meanwhile&#44; 43&#46;5&#37; of all MDs were due to direct causes&#44; the main one being pulmonary thromboembolism&#46; Pregnancy-induced hypertensive diseases were the fourth cause of death&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In the United States&#44; the main cause of MD is indirect obstetric morbidity with cardiovascular diseases &#40;15&#46;5&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> as the leading cause of death followed by pregnancy-induced hypertensive disease &#40;6&#46;8&#37;&#41; &#40;8th place&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> However&#44; in other Mexican reports&#44; most admissions and deaths at the ICU setting are due to direct obstetric morbidity&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Peripartum cardiomyopathy and acute fatty liver of pregnancy &#40;AFLP&#41; were the 2 major conditions that triggered the highest lethality rates &#40;66&#46;6&#37; and 33&#46;3&#37;&#44; respectively&#41;&#46; Unlike what has been reported in the medical literature&#44; the average mortality rate was 10&#37; for peripartum cardiomyopathy<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> and 10&#37; to 15&#37; for AFLP&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> On the other hand&#44; pregnancy-induced hypertensive disease had a lower lethality rate &#40;6&#37;&#41; compared to what the study conducted by Curiel et al&#46; reported &#40;a 1&#46;5&#37; lethality rate&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> It is estimated that 0&#46;8&#37; of all cases of SMM end up in MD&#59;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> however&#44; the rate of MD in our cohort was 7&#37;&#44; nearly 10 times higher&#46; This may be explained by 3 situations&#58; a&#41; tertiary referral centers admitting obstetric patients referred from other units that manage complex underlying conditions&#59; b&#41; patients included in the study who did not receive medical attention or did not respond to the early management attempted in other centers&#44; and c&#41; the delays reported when arriving to this unit since the beginning of the complication are up to 3&#46;1 days on average&#46; The aforementioned conditions cause more adverse events in obstetric patients admitted to this unit which&#44; in turn&#44; compromise the course of their disease&#46; The high mortality rate seen in obstetric patients from tertiary referral centers has also been reported by other authors&#58; In their cohort of 232 women with SMM from a tertiary center&#44; Blanco et al&#46; reported a 3&#46;8&#37; mortality rate&#59;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> similarly&#44; Paternina et al&#46; reported a 4&#46;7&#37; mortality rate in 625 patients with SMM&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The APACHE II&#44; APACHE II-M&#44; SOFA&#44; and O-SOFA scores were correlated with findings like the use of vasoactive amines and mechanical ventilation&#44; which confirmed their possible utility to define the subgroup of patients with poor disease progression although these models are only validated to predict mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> All models discriminated between survivors and non-survivors without any significant differences among their different AUC-ROCs&#46; This is contrary to the best discrimination of the O-SOFA model &#40;AUC-ROC&#8239;&#61;&#8239;0&#46;86&#41; compared to the SOFA &#40;AUC-ROC&#8239;&#61;&#8239;0&#46;79&#41; as reported by Blanco et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Regarding the selected cohort points&#44; the APACHE II and the APACHE II-M scores had better sensitivity and specificity&#46; However&#44; the PPV of all models was low &#40;&#60;&#8239;60&#37;&#41; and its best utility was for its high NPV &#40;&#62;&#8239;95&#37;&#41;&#46; No model discriminated or calibrated subgroups of pregnant women or septic subgroups separately&#46; This is due to the fact that only 1 out of 20 maternal deaths occurred in a pregnant woman and another one due to a septic process unlike the cohorts of Blanco et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and Paternina et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> where these subgroups are far better represented&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Using the mortality ratio&#44; the APACHE II-M model obtained the best value &#40;closer to 1&#41;&#46; This result is consistent with that reported by Paternina et al&#46; who maintain a high discrimination value &#40;AUC-ROC of 0&#46;86&#41; but improves calibration at a mortality ratio of 0&#46;85 compared to 0&#46;30 of the original APACHE II score&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The Hosmer-Lemeshow test for goodness of fit proved there is no calibration in the predictions made by the APACHE II and the O-SOFA models &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;034 and <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;039&#44; respectively&#41;&#46; In patients with lower mortality risk &#40;most patients in our cohort&#41; the APACHE II-M model made a right estimate of the mortality rate&#44; but as severity went up it started underestimating mortality rate&#46; On the other hand&#44; the APACHE II model overestimates mortality in less severe patients and underestimates it in more severe patients&#44; which explains its predictions null calibration&#46; Both the SOFA and the O-SOFA models overestimated the risk of death&#46; Still&#44; the overestimation of the O-SOFA score was higher&#44; meaning that its calibration was null in our cohort&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The strengths of the studio are that it compares the validity of its 2 components &#40;discrimination and calibration&#41; in 2 prognostic models for general ICU patients&#46; Also&#44; its personalized versions for obstetric patients&#44; a comparison that had not been drawn together before for the different models in 1 same cohort&#59; its internal validity comes from the use of validated statistical tools and from the fact that the patients who were not included in the study due to the lack of data in the clinical history only accounted for 1&#46;6&#37; of the sample&#44; which is why it was considered an insignificant loss&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The limitations of this study are selection bias and its poor external validity given it is a single-center trial and the cohort analyzed is only representative of a minority of all patients with severe maternal outcomes from the region who&#44; due to the severity or complexity of their clinical state&#44; were referred to our hospital considering that it does not have an obstetric ICU and only 6&#46;7&#37; of all admissions are obstetric patients&#59; however&#44; thanks to its therapeutic resources and extracorporeal support it is a reference centers for critically ill patients&#46; Another weakness of the study is the small number of pregnant &#40;10 patients&#41; and septic women &#40;15 patients&#41; included&#44; which prevented the analysis of the prognostic model validity in these subgroups&#46; Similarly&#44; another study limitation is the fact that only 10 deaths were reported&#44; which may lead to erroneous conclusions on the performance of the scales under analysis&#46; No autopsies were performed in any of the patients either to find out the causes of death&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">We found a favorable tendency towards the prognostic validity of the APACHE II-M score to predict MD thanks to its improved calibration compared to the original APACHE II score&#44; and a negative tendency on the validity of the O-SOFA score in the prediction of MD compared to the original SOFA score due to its lower calibration capabilities&#46; According to our results&#44; the use of the APACHE II-M model can be recommended to assess the prognosis of mortality in women with SMM&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Authors</span><p id="par0090" class="elsevierStylePara elsevierViewall">Baltazar Jonguitud L&#243;pez designed the research&#44; manuscript&#44; publication&#44; and data mining protocols&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Daniel &#193;lvarez Lara reviewed and provided counseling during the design phase of the research protocol&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Gerardo del Carmen Palacios Saucedo provided counseling during the design phase of the research and manuscript protocols&#46; Statistical analysis&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Miguel &#193;ngel Sosa Medell&#237;n provided counseling during the design phase of the research protocol&#46; Statistical analysis&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Fabio Montoya Barajas conducted data mining and provided counseling during the design phase of the manuscript protocol&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">None reported whatsoever&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">To compare the prognostic validity of the APACHE II-M and O-SOFA scales versus the APACHE II and SOFA to predict mortality in patients with severe maternal morbidity&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A retrospective&#44; longitudinal and analytical cohort study was carried out&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Setting</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Medical-surgical intensive care unit &#40;ICU&#41; of a tertiary hospital&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Patients</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Pregnant or puerperal patients of any age admitted to the ICU&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Interventions</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Calculation of prognostic scores upon admission&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Variables of interest</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">APACHE II&#44; SOFA&#44; APACHE II-M and O-SOFA scores and maternal mortality&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">A total of 141 patients were included&#46; The majority &#40;70&#46;2&#37;&#41; were puerperal&#46; The most frequent diagnosis was gestational hypertensive disease &#40;50 cases&#41;&#46; The discrimination of each prognostic model was estimated with the area under the ROC curve &#40;AUC-ROC&#41;&#46; The calibration was estimated using the mortality ratio and the Hosmer-Lemeshow statistic&#46; The four scales discriminated between survivors and non-survivors with areas under the curve &#62; 0&#46;85&#46; The APACHE II-M model was the predictive model with the highest discrimination and calibration&#46; In the Hosmer-Lemeshow regression analysis&#44; mortality as predicted by the APACHE II and O-SOFA was significantly different from the observed mortality&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">The APACHE II-M exhibited the greatest prognostic validity in predicting maternal mortality&#46; This difference was given by its improvement in calibration&#46;</p></span>"
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            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Design"
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            "identificador" => "abst0015"
            "titulo" => "Setting"
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            "identificador" => "abst0020"
            "titulo" => "Patients"
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            "identificador" => "abst0025"
            "titulo" => "Interventions"
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            "titulo" => "Results"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Objetivo</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Comparar la validez pron&#243;stica del APACHE II-M y O-SOFA versus el APACHE II y SOFA para predecir mortalidad en pacientes con morbilidad materna severa&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Dise&#241;o</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohorte&#44; retrospectivo&#44; longitudinal y anal&#237;tico&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">&#193;mbito</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Unidad de cuidados intensivos &#40;UCI&#41; m&#233;dico-quir&#250;rgica de un hospital de tercer nivel&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">pacientes embarazadas o pu&#233;rperas de cualquier edad ingresadas a la UCI&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Intervenciones</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">c&#225;lculo de escores pron&#243;sticos al ingreso&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variables de inter&#233;s</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">APACHE II&#44; SOFA&#44; APACHE II-M&#44; O-SOFA y mortalidad materna&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 141 pacientes&#46; Noventa y nueve &#40;70&#46;2&#37;&#41; fueron pu&#233;rperas&#46; El diagn&#243;stico m&#225;s frecuente fue la enfermedad hipertensiva del embarazo &#40;50 casos&#41;&#46; La discriminaci&#243;n de cada modelo pron&#243;stico se estim&#243; con el &#225;rea bajo la curva ROC &#40;ABC-ROC&#41;&#46; La calibraci&#243;n se estim&#243; utilizando la raz&#243;n de mortalidad y el estad&#237;stico de Hosmer-Lemeshow&#46; Las cuatro escalas discriminaron entre supervivientes y no supervivientes con &#225;reas bajo la curva &#62;0&#46;85&#46; El modelo APACHE II-M fue el modelo pron&#243;stico con mayor discriminaci&#243;n y calibraci&#243;n&#46; En la regresi&#243;n de Hosmer-Lemeshow la predicci&#243;n de mortalidad de APACHE II y O-SOFA fue significativamente diferente a las muertes observadas&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusiones</span><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">el APACHE II-M tuvo la mayor validez pron&#243;stica para predecir muerte materna&#46; Esta diferencia est&#225; dada por su mejor&#237;a en la calibraci&#243;n&#46;</p></span>"
        "secciones" => array:8 [
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            "identificador" => "abst0045"
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            "titulo" => "Dise&#241;o"
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          2 => array:2 [
            "identificador" => "abst0055"
            "titulo" => "&#193;mbito"
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          3 => array:2 [
            "identificador" => "abst0060"
            "titulo" => "Pacientes"
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          4 => array:2 [
            "identificador" => "abst0065"
            "titulo" => "Intervenciones"
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          5 => array:2 [
            "identificador" => "abst0070"
            "titulo" => "Variables de inter&#233;s"
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          6 => array:2 [
            "identificador" => "abst0075"
            "titulo" => "Resultados"
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            "identificador" => "abst0080"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">EPV&#44; events per variable&#59; LP&#44; lower probability&#59; TDF&#44; total degrees of freedom&#46;</p>"
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      1 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Please cite this article as&#58; Jonguitud L&#243;pez B&#44; &#193;lvarez Lara D&#44; Sosa Medell&#237;n MA&#44; Montoya Barajas F&#44; Palacios Saucedo GC&#46; Comparaci&#243;n de 4 escalas pron&#243;sticas para predecir mortalidad en pacientes con morbilidad materna severa&#46; Med Clin &#40;Barc&#41;&#46; 2021&#59;45&#58;156&#8211;163&#46;</p>"
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            "apendice" => "<p id="par0125" class="elsevierStylePara elsevierViewall">The following are Supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0040"
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        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
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          0 => array:3 [
            "identificador" => "at0030"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">ROC curves of the APACHE II-M&#44; O-SOFA&#44; APACHE&#44; and SOFA models in a cohort of 141 patients with severe maternal morbidity&#46; APACHE II-M&#44; modified version of the Acute Physiology and Chronic Health Evaluation II for obstetric patients&#59; AUC&#44; area under the curve&#59; O-SOFA&#44; modified version of the Sequential Organ Failure Assessment Score for obstetric patients&#46; APACHE II&#44; Acute Physiology and Chronic Health Evaluation II&#59; ROC&#44; receiver operating characteristics&#59; SOFA&#44; Sequential Organ Failure Assessment Score&#46;</p>"
        ]
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      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1801
            "Ancho" => 2173
            "Tamanyo" => 194034
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        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0035"
            "detalle" => "Fig&#46; "
            "rol" => "short"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Calibration chart of the APACHE II-M&#44; O-SOFA&#44; APACHE&#44; and SOFA predictive models in a cohort of 141 patients with severe maternal morbidity&#58; observed mortality &#40;axis Y&#41; vs estimated mortality &#40;axis X&#41;&#46; APACHE II&#44; Acute Physiology and Chronic Health Evaluation II&#59; APACHE II-M&#44; modified version of the Acute Physiology and Chronic Health Evaluation II for obstetric patients&#59; O-SOFA&#44; modified version of the Sequential Organ Failure Assessment Score for obstetric patients&#59; SOFA&#44; Sequential Organ Failure Assessment Score&#46;</p>"
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        "etiqueta" => "Table 1"
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">APACHE II-M&#44; modified version of the Acute Physiology and Chronic Health Evaluation II for obstetric patients&#59; APACHE II&#44; Acute Physiology and Chronic Health Evaluation II&#59; ICU&#44; intensive care unit&#59; IQR&#44; interquartile range&#59; O-SOFA&#44; modified version of the Sequential Organ Failure Assessment Score for obstetric patients&#59; SD&#44; standard deviation&#59; SOFA&#44; Sequential Organ Failure Assessment Score&#46;</p>"
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total &#40;n&#8239;&#61;&#8239;141&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Survivors &#40;n&#8239;&#61;&#8239;131&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Non-survivors &#40;n&#8239;&#61;&#8239;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;09&#8239;&#177;&#8239;7&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;7&#8239;&#177;&#8239;6&#46;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;8&#8239;&#177;&#8239;15&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#46;043&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Previous pregnancies &#40;median&#47;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#8722;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#8722;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;5 &#40;2&#8722;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;901&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Weeks of pregnancy</span><span class="elsevierStyleItalic">&#40;median&#47; IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">33&#46;1 &#40;27&#8722;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;27&#46;2&#8722;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;18&#8722;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#46;501&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbidity &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">55 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">52 &#40;36&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#46;882&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus type 2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;2&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">---&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Arterial hypertension&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neurological&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiovascular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pulmonary&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Endocrine&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hepatic&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Renal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rheumatological&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oncological&#47;hematological&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Other&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Pregnancy at admission &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Puerperium at admission &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Days of clinical progression</span><a class="elsevierStyleCrossRefs" href="#tblfn0005"><span class="elsevierStyleSup">a&#44;b</span></a><span class="elsevierStyleItalic">&#40;mean&#47;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">APACHE II &#40;median&#47;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;20&#8722;26&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">64 &#40;45&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Obstetric bleeding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pregnancy-induced hypertensive disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;35&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Obstetric sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>AFLP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#40;54&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PTE&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Non-obstetric sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;8&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Endocrine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;3&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acute pancreatitis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;8&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oncological&#47;hematological&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;9&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&#40;9&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">ACU&#44; area under the curve&#59; APACHE II-M&#44; modified version of the Acute Physiology and Chronic Health Evaluation II for obstetric patients&#59; 95&#37;CI&#44; 95&#37; confidence intervals&#59; APACHE II&#44; Acute Physiology and Chronic Health Evaluation II&#59; MR&#44; mortality ratio &#40;deaths observed&#47;deaths estimated&#41;&#59; NPV&#44; negative predictive value&#59; O-SOFA&#44; modified version of the Sequential Organ Failure Assessment Score for obstetric patients&#59; PPV&#44; positive predictive value&#59; SOFA&#44; Sequential Organ Failure Assessment Score&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">APACHE II-M&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">AUC &#40;95&#37;CI&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;976 &#40;0&#46;935&#8722;0&#46;994&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;976 &#40;0&#46;935&#8722;0&#46;994&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;839 &#40;0&#46;768&#8722;0&#46;895&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  "referenciaCompleta" => "Word Health Organization&#58; The Near-Miss Approach for Maternal Health&#46; Evaluating the Quality of Care for Severe Pregnancy Complications&#46; Available at&#58; Attp&#58;&#47;&#47;whqlibdoc&#46;who&#46;int&#47;publications&#47;2011&#47;9789241502221&#95;eng&#46;pdf&#46; &#40;consultado el 27 de abril del 2019&#41;&#46;"
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Original
Comparison of four prognostic scales for predicting mortality in patients with severe maternal morbidity
Comparación de 4 escalas pronósticas para predecir mortalidad en pacientes con morbilidad materna severa
B. Jonguitud Lópeza,
Corresponding author
jl_bal@hotmail.com

Corresponding author.
, D. Álvarez Laraa, M.A. Sosa Medellínb, F. Montoya Barajasa, G.C. Palacios Saucedoc
a Unidad de Cuidados Intensivos, Hospital de especialidades en la Unidad Médica de Alta Especialidad N.º 25, IMSS, Monterrey, Nuevo León, Mexico
b Unidad de Cuidados Intensivos, Hospital de Traumatología y Ortopedia de la Unidad Médica de Alta Especialidad N.º 21, IMSS, Monterrey, Nuevo León, Mexico
c Departamento de Ense˜nanza, Hospital de especialidades en la Unidad Médica de Alta Especialidad N.º 25, IMSS, Monterrey, Nuevo León, Mexico
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severe maternal outcomes including cases of MD and extreme maternal morbidity&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The American College of Obstetricians and Gynecologists uses the concept of severe maternal morbidity &#40;SMM&#41; including pregnant women or women in the pregnancy-puerperium period who were admitted to the intensive care unit &#40;UCI&#41; or who received&#44; at least&#44; 4 erythrocitary concentrates&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Similarly&#44; potentially life-threatening conditions are clinical situations that threaten a woman&#8217;s life during her pregnancy&#44; delivery or the puerperium period<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> such as&#58; a&#41; direct obstetric morbidity resulting from pregnancy&#44; delivery or puerperium complications due to medical and&#47;or surgical interventions or ommissions or incorrect therapy &#40;eg&#44; obstetric bleeding&#41;&#59; or b&#41; indirect obstetric morbidity associated with preexisting conditions before pregnancy or during pregnancy&#44; not due to any obstetric causes&#44; but aggravated by the physiological effects of pregnancy &#40;eg&#44; valvular heart disease&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A total of 830 women die every day across the world due to pregnancy related causes&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> From 2014 to 2016 the United Kingdom reported a total of 259 MDs &#40;9&#46;8 women for every 100 000 live births &#40;LBs&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The United States reported a total of 18 MDs&#47;100 000 LBs&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> For every MD there are 118 cases of SMM<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and between 0&#46;5&#37; and 1&#46;3&#37; of pregnancies will be associated with SMM&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Inappropriate therapies&#44; delayed diagnoses&#44; and referral to a special care level contribute to maternal mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Between 55&#37; and 70&#37; of the cases of MD received suboptimal medical care&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> That is why the target established by the WHO is to reduce the overall MD rate to &#60; 70&#47;100 000 LBs&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The United Kingdom will try to cut the number of MD in half by 2025&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">On the other hand&#44; a prognostic model is the combination of multiple predictors to assess the risk of a specific outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> These models are useful to characterize the severity of the disease in clinical trials and assess the performance of ICUs&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Their validity &#40;capacity to predict a specific result&#41; includes&#58; a&#41; the discrimination or capacity to distinguish different individuals based on their different outcomes&#44; and b&#41; calibration or match between the probabilities observed and the probabilities anticipated of an occurring event&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Prognostic models in obstetric patients are not accurate because&#58; 1&#41; we are talking about young female patients with few comorbidities&#59; 2&#41; many obstetric complications improve significantly after pregnancy&#44; and 3&#41; due to the normal physiological changes of pregnancy&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> The Acute Physiology and Chronic Health Evaluation II &#40;APACHE II&#41; is the predictive model most commonly used at the ICU setting&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> However&#44; 5 of its variables have different reference values during pregnancy &#40;arterial blood pressure&#44; heart rate&#44; hematocrit&#44; creatinine and leukocyte levels&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;13</span></a> and it also overestimates the mortality rate&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The Sequential Organ Failure Assessment &#40;SOFA&#41; score assesses the degree of organ dysfunction and is less affected by the physiological changes of pregnancy&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Prognostic models can be improved by altering their equations or changing their variables&#44; a process known as personalization or recalibration<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Blanco et al&#46; propose an obstetric SOFA &#40;O-SOFA&#41; created from 2 modifications of the SOFA model &#40;Appendix B supplementary data 1&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and Paternina et al&#46; propose a modified APACHE II score &#40;APACHE II-M&#41; by changing the mathematical equation of the original APACHE II to better serve its validity among the obstetric population &#40;Appendix B supplementary data 1&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The objective of this study was to compare the validity of the APACHE II&#44; the APACHE II-M&#44; the SOFA&#44; and the O-SOFA to predict mortality in a cohort of patients with SMM who were admitted to our ICU&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Patients and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">Retrospective&#44; cohort study conducted at the ICU of the IMSS High Specialty Medical Unit 25 of Monterrey&#44; Nuevo Le&#243;n&#44; Mexico&#46; It was approved back on November 27&#44; 2018 by the Health Research Local Committee 1901with registry &#35;R-2018-1901-105&#46; It recruited patients from December 2015 through July 2018&#46; According to Peduzzi formula<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a><span class="elsevierStyleItalic">n&#8239;&#61;&#8239;&#40;TDF&#8239;&#215;&#8239;EPV&#47;LP&#41;</span><a class="elsevierStyleCrossRef" href="#fn0005"><span class="elsevierStyleSup">1</span></a> a minimum of 131 patients are needed for the analysis to be statistically significant&#46; The study used a convenience sampling method&#46; Only women who met the definition of SMM were included &#40;pregnant women or within the first 42 days since full-term pregnancy admitted to the ICU&#41;&#46; Women without enough information on the health records to assess their prognostic scales at the ICU admission were excluded&#46; In case of ICU readmission during the same hospitalization only the data from the first admission were included&#46; Patients were followed during hospitalization until their death or admission&#46; The patients&#8217; demographic data &#40;age&#44; number of pregnancies&#44; deliveries&#44; c-sections&#44; miscarriages&#44; gestational age&#44; and comorbidities&#41;&#44; main diagnosis at admission&#44; time elapsed since the beginning of the complication until admission to our unit&#44; and the variables needed to estimate the APACHE II&#44; APACHE II-M&#44; SOFA&#44; and O-SOFA scores were included&#46; Also&#44; clinical data on the patients&#8217; clinical progression such as the use of mechanical ventilation&#44; vasopressors&#44; renal replacement therapy&#44; and days at the ICU were included too&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Demographic data were documented with descriptive statistics using measures of central tendency and dispersion&#58; mean and standard deviation were used to expressed variables with normal distribution&#59; median and interquartile range were used to expressed variables without a normal distribution&#46; The inferential analysis was conducted using the Student <span class="elsevierStyleItalic">t</span>-test for independent samples or the Mann-Whitney <span class="elsevierStyleItalic">U</span> test for quantitative variables based on their normal distribution&#46; The chi-square test or Fisher&#8217;s exact test were used for the qualitative variables&#46; The degree of discrimination of every prognostic model was estimated using the area under the curve &#40;AUC&#41; of the receiver operating characteristics &#40;ROC&#41; and their 95&#37; confidence intervals &#40;95&#37;CI&#41;&#46; Calibration was estimated using the standard mortality ratio &#40;the ratio between the deaths seen and the deaths estimated&#41; and Hosmer-Lemeshow test for goodness of fit&#46; Sensitivity&#44; specificity&#44; positive predictive value &#40;PPV&#41;&#44; and negative predictive value &#40;NPV&#41; of every prognostic score was estimated as well&#46; The SPSS v 20&#46;0 software was used for statistical analysis&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">During the 56-month follow-up&#44; 6&#46;7&#37; of ICU admissions were obstetric patients &#40;143 admissions due to SMM&#41; all of them referred from other hospitals&#46; Two patients were excluded due to insufficient information to estimate some of the prognostic scales at admission&#46; The final analysis &#40;141 patients&#41; included 99 women in the pregnancy-puerperium period &#40;70&#46;3&#37;&#41; and 42 pregnant women &#40;29&#46;7&#37;&#41;&#46; A total of 62&#46;5&#37; of women in the pregnancy-puerperium period and 45&#37; of pregnant women had their complications in the third trimester&#46; Data on the clinical characteristics&#44; prognostic scores&#44; and disease progression are shown on <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Most admissions &#40;54&#46;6&#37;&#41; were due to indirect obstetric morbidity with an average time of 3&#46;1&#8239;&#177;&#8239;2&#46;5 days since the beginning of the complication until ICU admission&#46; The main causes of indirect obstetric morbidity were oncological-hematological &#40;Appendix B supplementary data 2&#41;&#46; The most common diagnosis at admission was pregnancy-induced hypertensive disease &#40;50 cases&#41;&#46; A total of 23 cases &#40;16&#46;3&#37;&#41; were classified as HELLP syndrome&#44; 19 &#40;13&#46;4&#37;&#41; as severe preeclampsia&#44; and 8 &#40;5&#46;6&#37;&#41; as eclampsia&#46; Diagnoses at admission and lethality are shown on <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; There were significant differences in the use of mechanical ventilation&#44; vasopressors&#44; and inotropic drugs between survivors and non-survivors&#46; However&#44; no differences were seen in the use of renal replacement therapy and days on intensive therapy &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The 4 prognostic scales were associated with the use of mechanical ventilation&#44; vasopressors&#44; renal replacement therapy&#44; and days at the ICU &#40;Appendix B supplementary data 2&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The characteristics of how the scores performed are shown on <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; In our cohort&#44; the rate of MD was 7&#37; and the 4 scales discriminated between survivors and non-survivors&#46; The largest ACU-ROC of all was that of the APACHE II and the APACHE II-M models &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; although this difference was not statistically significant &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;105&#41;&#46; All prognostic scales had low PPVs and high NPVs&#46; The 4 scales lost their statistical significance when they assessed pregnant patients and septic patients separately &#40;Appendix B supplementary data 2&#41;&#46; Based on the mortality ratio&#44; the APACHE II-M model predicted a lower number of deaths than observed&#46; The remaining models overestimated the risk&#46; In the Hosmer-Lemeshow logistic regression model the mortality prediction of both the APACHE II and the O-SOFA model were significantly different compared to the number of deaths reported &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">The 4 models analyzed showed discrimination capabilities&#46; Regarding calibration&#44; both the APACHE II-M and the SOFA models confirmed their superiority&#46; The patients&#8217; age of the non-survivors group &#40;32&#46;8&#8239;&#177;&#8239;15&#46;7 years&#44; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;043&#41; was older compared to the survivors group&#46; Consistent with the MBRRACE-UK report that described a higher risk of MD with age &#40;7&#47;100 000 in the group of 20-to-24 year-old patients&#41;&#44; this risk duplicated to 14&#47;100 000 in women between 35 and 39 years-old&#44; and tripled to 22&#47;100 000 in women &#62; 40&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In this cohort&#44; indirect obstetric morbidity was more common &#40;54&#46;6&#37;&#41; including neurological&#44; oncological&#44; septic processes&#44; and acute pancreatitis in order of frequency&#46; Regarding direct obstetric morbidity&#44; pregnancy-induced hypertensive complications &#40;35&#37;&#41; and obstetric bleeding &#40;5&#46;6&#37;&#41; were the main diagnoses&#46; On the contrary in the cohort of the study conducted by Rojas et al&#46;&#44; admissions due to pregnancy-induced hypertensive disease and obstetric bleeding were predominant&#46; Also&#44; these were the 2 main causes of death&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> This difference can be explained by the fact that the ICU of the study conducted by Rojas is obstetric unlike our ICU &#40;polyvalent&#41;&#46; In our cohort&#44; the main cause of MD was pregnancy-induced hypertensive disease &#40;30&#37;&#41; followed by cardiovascular diseases &#40;20&#37;&#41; and neurological conditions &#40;20&#37;&#41;&#46; This contrasts with the data from the United Kingdom where 56&#46;4&#37; of all MDs were due to indirect causes such as heart disease and the causes of direct MD &#40;43&#46;5&#37; of the cases&#41;&#46; Meanwhile&#44; 43&#46;5&#37; of all MDs were due to direct causes&#44; the main one being pulmonary thromboembolism&#46; Pregnancy-induced hypertensive diseases were the fourth cause of death&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In the United States&#44; the main cause of MD is indirect obstetric morbidity with cardiovascular diseases &#40;15&#46;5&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> as the leading cause of death followed by pregnancy-induced hypertensive disease &#40;6&#46;8&#37;&#41; &#40;8th place&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> However&#44; in other Mexican reports&#44; most admissions and deaths at the ICU setting are due to direct obstetric morbidity&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Peripartum cardiomyopathy and acute fatty liver of pregnancy &#40;AFLP&#41; were the 2 major conditions that triggered the highest lethality rates &#40;66&#46;6&#37; and 33&#46;3&#37;&#44; respectively&#41;&#46; Unlike what has been reported in the medical literature&#44; the average mortality rate was 10&#37; for peripartum cardiomyopathy<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> and 10&#37; to 15&#37; for AFLP&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> On the other hand&#44; pregnancy-induced hypertensive disease had a lower lethality rate &#40;6&#37;&#41; compared to what the study conducted by Curiel et al&#46; reported &#40;a 1&#46;5&#37; lethality rate&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> It is estimated that 0&#46;8&#37; of all cases of SMM end up in MD&#59;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> however&#44; the rate of MD in our cohort was 7&#37;&#44; nearly 10 times higher&#46; This may be explained by 3 situations&#58; a&#41; tertiary referral centers admitting obstetric patients referred from other units that manage complex underlying conditions&#59; b&#41; patients included in the study who did not receive medical attention or did not respond to the early management attempted in other centers&#44; and c&#41; the delays reported when arriving to this unit since the beginning of the complication are up to 3&#46;1 days on average&#46; The aforementioned conditions cause more adverse events in obstetric patients admitted to this unit which&#44; in turn&#44; compromise the course of their disease&#46; The high mortality rate seen in obstetric patients from tertiary referral centers has also been reported by other authors&#58; In their cohort of 232 women with SMM from a tertiary center&#44; Blanco et al&#46; reported a 3&#46;8&#37; mortality rate&#59;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> similarly&#44; Paternina et al&#46; reported a 4&#46;7&#37; mortality rate in 625 patients with SMM&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The APACHE II&#44; APACHE II-M&#44; SOFA&#44; and O-SOFA scores were correlated with findings like the use of vasoactive amines and mechanical ventilation&#44; which confirmed their possible utility to define the subgroup of patients with poor disease progression although these models are only validated to predict mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> All models discriminated between survivors and non-survivors without any significant differences among their different AUC-ROCs&#46; This is contrary to the best discrimination of the O-SOFA model &#40;AUC-ROC&#8239;&#61;&#8239;0&#46;86&#41; compared to the SOFA &#40;AUC-ROC&#8239;&#61;&#8239;0&#46;79&#41; as reported by Blanco et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Regarding the selected cohort points&#44; the APACHE II and the APACHE II-M scores had better sensitivity and specificity&#46; However&#44; the PPV of all models was low &#40;&#60;&#8239;60&#37;&#41; and its best utility was for its high NPV &#40;&#62;&#8239;95&#37;&#41;&#46; No model discriminated or calibrated subgroups of pregnant women or septic subgroups separately&#46; This is due to the fact that only 1 out of 20 maternal deaths occurred in a pregnant woman and another one due to a septic process unlike the cohorts of Blanco et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and Paternina et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> where these subgroups are far better represented&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Using the mortality ratio&#44; the APACHE II-M model obtained the best value &#40;closer to 1&#41;&#46; This result is consistent with that reported by Paternina et al&#46; who maintain a high discrimination value &#40;AUC-ROC of 0&#46;86&#41; but improves calibration at a mortality ratio of 0&#46;85 compared to 0&#46;30 of the original APACHE II score&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The Hosmer-Lemeshow test for goodness of fit proved there is no calibration in the predictions made by the APACHE II and the O-SOFA models &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;034 and <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;039&#44; respectively&#41;&#46; In patients with lower mortality risk &#40;most patients in our cohort&#41; the APACHE II-M model made a right estimate of the mortality rate&#44; but as severity went up it started underestimating mortality rate&#46; On the other hand&#44; the APACHE II model overestimates mortality in less severe patients and underestimates it in more severe patients&#44; which explains its predictions null calibration&#46; Both the SOFA and the O-SOFA models overestimated the risk of death&#46; Still&#44; the overestimation of the O-SOFA score was higher&#44; meaning that its calibration was null in our cohort&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The strengths of the studio are that it compares the validity of its 2 components &#40;discrimination and calibration&#41; in 2 prognostic models for general ICU patients&#46; Also&#44; its personalized versions for obstetric patients&#44; a comparison that had not been drawn together before for the different models in 1 same cohort&#59; its internal validity comes from the use of validated statistical tools and from the fact that the patients who were not included in the study due to the lack of data in the clinical history only accounted for 1&#46;6&#37; of the sample&#44; which is why it was considered an insignificant loss&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The limitations of this study are selection bias and its poor external validity given it is a single-center trial and the cohort analyzed is only representative of a minority of all patients with severe maternal outcomes from the region who&#44; due to the severity or complexity of their clinical state&#44; were referred to our hospital considering that it does not have an obstetric ICU and only 6&#46;7&#37; of all admissions are obstetric patients&#59; however&#44; thanks to its therapeutic resources and extracorporeal support it is a reference centers for critically ill patients&#46; Another weakness of the study is the small number of pregnant &#40;10 patients&#41; and septic women &#40;15 patients&#41; included&#44; which prevented the analysis of the prognostic model validity in these subgroups&#46; Similarly&#44; another study limitation is the fact that only 10 deaths were reported&#44; which may lead to erroneous conclusions on the performance of the scales under analysis&#46; No autopsies were performed in any of the patients either to find out the causes of death&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">We found a favorable tendency towards the prognostic validity of the APACHE II-M score to predict MD thanks to its improved calibration compared to the original APACHE II score&#44; and a negative tendency on the validity of the O-SOFA score in the prediction of MD compared to the original SOFA score due to its lower calibration capabilities&#46; According to our results&#44; the use of the APACHE II-M model can be recommended to assess the prognosis of mortality in women with SMM&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Authors</span><p id="par0090" class="elsevierStylePara elsevierViewall">Baltazar Jonguitud L&#243;pez designed the research&#44; manuscript&#44; publication&#44; and data mining protocols&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Daniel &#193;lvarez Lara reviewed and provided counseling during the design phase of the research protocol&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Gerardo del Carmen Palacios Saucedo provided counseling during the design phase of the research and manuscript protocols&#46; Statistical analysis&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Miguel &#193;ngel Sosa Medell&#237;n provided counseling during the design phase of the research protocol&#46; Statistical analysis&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Fabio Montoya Barajas conducted data mining and provided counseling during the design phase of the manuscript protocol&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">None reported whatsoever&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">To compare the prognostic validity of the APACHE II-M and O-SOFA scales versus the APACHE II and SOFA to predict mortality in patients with severe maternal morbidity&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A retrospective&#44; longitudinal and analytical cohort study was carried out&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Setting</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Medical-surgical intensive care unit &#40;ICU&#41; of a tertiary hospital&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Patients</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Pregnant or puerperal patients of any age admitted to the ICU&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Interventions</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Calculation of prognostic scores upon admission&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Variables of interest</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">APACHE II&#44; SOFA&#44; APACHE II-M and O-SOFA scores and maternal mortality&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">A total of 141 patients were included&#46; The majority &#40;70&#46;2&#37;&#41; were puerperal&#46; The most frequent diagnosis was gestational hypertensive disease &#40;50 cases&#41;&#46; The discrimination of each prognostic model was estimated with the area under the ROC curve &#40;AUC-ROC&#41;&#46; The calibration was estimated using the mortality ratio and the Hosmer-Lemeshow statistic&#46; The four scales discriminated between survivors and non-survivors with areas under the curve &#62; 0&#46;85&#46; The APACHE II-M model was the predictive model with the highest discrimination and calibration&#46; In the Hosmer-Lemeshow regression analysis&#44; mortality as predicted by the APACHE II and O-SOFA was significantly different from the observed mortality&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">The APACHE II-M exhibited the greatest prognostic validity in predicting maternal mortality&#46; This difference was given by its improvement in calibration&#46;</p></span>"
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            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Design"
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            "identificador" => "abst0015"
            "titulo" => "Setting"
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            "identificador" => "abst0020"
            "titulo" => "Patients"
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            "identificador" => "abst0025"
            "titulo" => "Interventions"
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            "titulo" => "Results"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Objetivo</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Comparar la validez pron&#243;stica del APACHE II-M y O-SOFA versus el APACHE II y SOFA para predecir mortalidad en pacientes con morbilidad materna severa&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Dise&#241;o</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohorte&#44; retrospectivo&#44; longitudinal y anal&#237;tico&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">&#193;mbito</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Unidad de cuidados intensivos &#40;UCI&#41; m&#233;dico-quir&#250;rgica de un hospital de tercer nivel&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">pacientes embarazadas o pu&#233;rperas de cualquier edad ingresadas a la UCI&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Intervenciones</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">c&#225;lculo de escores pron&#243;sticos al ingreso&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variables de inter&#233;s</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">APACHE II&#44; SOFA&#44; APACHE II-M&#44; O-SOFA y mortalidad materna&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 141 pacientes&#46; Noventa y nueve &#40;70&#46;2&#37;&#41; fueron pu&#233;rperas&#46; El diagn&#243;stico m&#225;s frecuente fue la enfermedad hipertensiva del embarazo &#40;50 casos&#41;&#46; La discriminaci&#243;n de cada modelo pron&#243;stico se estim&#243; con el &#225;rea bajo la curva ROC &#40;ABC-ROC&#41;&#46; La calibraci&#243;n se estim&#243; utilizando la raz&#243;n de mortalidad y el estad&#237;stico de Hosmer-Lemeshow&#46; Las cuatro escalas discriminaron entre supervivientes y no supervivientes con &#225;reas bajo la curva &#62;0&#46;85&#46; El modelo APACHE II-M fue el modelo pron&#243;stico con mayor discriminaci&#243;n y calibraci&#243;n&#46; En la regresi&#243;n de Hosmer-Lemeshow la predicci&#243;n de mortalidad de APACHE II y O-SOFA fue significativamente diferente a las muertes observadas&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusiones</span><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">el APACHE II-M tuvo la mayor validez pron&#243;stica para predecir muerte materna&#46; Esta diferencia est&#225; dada por su mejor&#237;a en la calibraci&#243;n&#46;</p></span>"
        "secciones" => array:8 [
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            "identificador" => "abst0045"
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            "titulo" => "Dise&#241;o"
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          2 => array:2 [
            "identificador" => "abst0055"
            "titulo" => "&#193;mbito"
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          3 => array:2 [
            "identificador" => "abst0060"
            "titulo" => "Pacientes"
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          4 => array:2 [
            "identificador" => "abst0065"
            "titulo" => "Intervenciones"
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          5 => array:2 [
            "identificador" => "abst0070"
            "titulo" => "Variables de inter&#233;s"
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          6 => array:2 [
            "identificador" => "abst0075"
            "titulo" => "Resultados"
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            "identificador" => "abst0080"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">EPV&#44; events per variable&#59; LP&#44; lower probability&#59; TDF&#44; total degrees of freedom&#46;</p>"
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      1 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Please cite this article as&#58; Jonguitud L&#243;pez B&#44; &#193;lvarez Lara D&#44; Sosa Medell&#237;n MA&#44; Montoya Barajas F&#44; Palacios Saucedo GC&#46; Comparaci&#243;n de 4 escalas pron&#243;sticas para predecir mortalidad en pacientes con morbilidad materna severa&#46; Med Clin &#40;Barc&#41;&#46; 2021&#59;45&#58;156&#8211;163&#46;</p>"
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            "apendice" => "<p id="par0125" class="elsevierStylePara elsevierViewall">The following are Supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0040"
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        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
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          0 => array:3 [
            "identificador" => "at0030"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">ROC curves of the APACHE II-M&#44; O-SOFA&#44; APACHE&#44; and SOFA models in a cohort of 141 patients with severe maternal morbidity&#46; APACHE II-M&#44; modified version of the Acute Physiology and Chronic Health Evaluation II for obstetric patients&#59; AUC&#44; area under the curve&#59; O-SOFA&#44; modified version of the Sequential Organ Failure Assessment Score for obstetric patients&#46; APACHE II&#44; Acute Physiology and Chronic Health Evaluation II&#59; ROC&#44; receiver operating characteristics&#59; SOFA&#44; Sequential Organ Failure Assessment Score&#46;</p>"
        ]
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      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1801
            "Ancho" => 2173
            "Tamanyo" => 194034
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        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0035"
            "detalle" => "Fig&#46; "
            "rol" => "short"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Calibration chart of the APACHE II-M&#44; O-SOFA&#44; APACHE&#44; and SOFA predictive models in a cohort of 141 patients with severe maternal morbidity&#58; observed mortality &#40;axis Y&#41; vs estimated mortality &#40;axis X&#41;&#46; APACHE II&#44; Acute Physiology and Chronic Health Evaluation II&#59; APACHE II-M&#44; modified version of the Acute Physiology and Chronic Health Evaluation II for obstetric patients&#59; O-SOFA&#44; modified version of the Sequential Organ Failure Assessment Score for obstetric patients&#59; SOFA&#44; Sequential Organ Failure Assessment Score&#46;</p>"
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        "etiqueta" => "Table 1"
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">APACHE II-M&#44; modified version of the Acute Physiology and Chronic Health Evaluation II for obstetric patients&#59; APACHE II&#44; Acute Physiology and Chronic Health Evaluation II&#59; ICU&#44; intensive care unit&#59; IQR&#44; interquartile range&#59; O-SOFA&#44; modified version of the Sequential Organ Failure Assessment Score for obstetric patients&#59; SD&#44; standard deviation&#59; SOFA&#44; Sequential Organ Failure Assessment Score&#46;</p>"
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total &#40;n&#8239;&#61;&#8239;141&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Survivors &#40;n&#8239;&#61;&#8239;131&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Non-survivors &#40;n&#8239;&#61;&#8239;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;09&#8239;&#177;&#8239;7&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;7&#8239;&#177;&#8239;6&#46;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;8&#8239;&#177;&#8239;15&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#46;043&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Previous pregnancies &#40;median&#47;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#8722;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#8722;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;5 &#40;2&#8722;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;901&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Weeks of pregnancy</span><span class="elsevierStyleItalic">&#40;median&#47; IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">33&#46;1 &#40;27&#8722;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;27&#46;2&#8722;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;18&#8722;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#46;501&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbidity &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">55 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">52 &#40;36&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#46;882&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus type 2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;2&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">---&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Arterial hypertension&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neurological&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiovascular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pulmonary&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Endocrine&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hepatic&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Renal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rheumatological&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oncological&#47;hematological&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Other&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Pregnancy at admission &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Puerperium at admission &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Days of clinical progression</span><a class="elsevierStyleCrossRefs" href="#tblfn0005"><span class="elsevierStyleSup">a&#44;b</span></a><span class="elsevierStyleItalic">&#40;mean&#47;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">APACHE II &#40;median&#47;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;20&#8722;26&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">64 &#40;45&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Obstetric bleeding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pregnancy-induced hypertensive disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;35&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Obstetric sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>AFLP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#40;54&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PTE&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Non-obstetric sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;8&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Endocrine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;3&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acute pancreatitis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;8&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oncological&#47;hematological&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;9&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&#40;9&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">ACU&#44; area under the curve&#59; APACHE II-M&#44; modified version of the Acute Physiology and Chronic Health Evaluation II for obstetric patients&#59; 95&#37;CI&#44; 95&#37; confidence intervals&#59; APACHE II&#44; Acute Physiology and Chronic Health Evaluation II&#59; MR&#44; mortality ratio &#40;deaths observed&#47;deaths estimated&#41;&#59; NPV&#44; negative predictive value&#59; O-SOFA&#44; modified version of the Sequential Organ Failure Assessment Score for obstetric patients&#59; PPV&#44; positive predictive value&#59; SOFA&#44; Sequential Organ Failure Assessment Score&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">APACHE II-M&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">AUC &#40;95&#37;CI&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;976 &#40;0&#46;935&#8722;0&#46;994&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;976 &#40;0&#46;935&#8722;0&#46;994&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;839 &#40;0&#46;768&#8722;0&#46;895&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  "referenciaCompleta" => "Word Health Organization&#58; The Near-Miss Approach for Maternal Health&#46; Evaluating the Quality of Care for Severe Pregnancy Complications&#46; Available at&#58; Attp&#58;&#47;&#47;whqlibdoc&#46;who&#46;int&#47;publications&#47;2011&#47;9789241502221&#95;eng&#46;pdf&#46; &#40;consultado el 27 de abril del 2019&#41;&#46;"
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Article information
ISSN: 21735727
Original language: English
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Year/Month Html Pdf Total
2024 November 4 6 10
2024 October 52 66 118
2024 September 46 37 83
2024 August 64 40 104
2024 July 52 44 96
2024 June 66 45 111
2024 May 65 46 111
2024 April 67 39 106
2024 March 58 28 86
2024 February 55 48 103
2024 January 55 33 88
2023 December 82 41 123
2023 November 65 45 110
2023 October 58 39 97
2023 September 53 36 89
2023 August 34 18 52
2023 July 45 32 77
2023 June 38 18 56
2023 May 55 41 96
2023 April 42 35 77
2023 March 74 25 99
2023 February 56 25 81
2023 January 38 26 64
2022 December 90 38 128
2022 November 75 40 115
2022 October 79 32 111
2022 September 65 27 92
2022 August 57 47 104
2022 July 43 37 80
2022 June 54 38 92
2022 May 47 38 85
2022 April 37 48 85
2022 March 56 51 107
2022 February 51 36 87
2022 January 52 33 85
2021 December 70 62 132
2021 November 52 34 86
2021 October 66 93 159
2021 September 29 41 70
2021 August 50 46 96
2021 July 39 35 74
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?