Intensive cave unit morbidity and mortality from eclampsia: An evaluation of the Acute Physiology and Chronic Health Evaluation II score and the Glasgow Coma Scale score

Objective: To determine the maternal morbidity and mortality in patients wi th eclampsia admitted to an intensive care unit (ICU), and to establish the efficacy of the Acute Physiology and Chronic Health Evaluation (APACHE) II score, the organ system failure score as defined by Knaus, and the Glasgow Coma Scale (GCS) score in predicting outcome. Design: Retrospective analysis of a 3.5-yr period. Setting: Surgical ICU in a university hospital. Patients: A total of 105 patients who were admitted with a diagnosis of ecl ampsia were studied. Interventions: Hone. Measurements and Main Results: The data captured included the reason for ad mission, maternal age, gestational age, parity, number of seizures, duratio n of ICU stay, anticonvulsant therapy, drug therapy, GCS score, APACHE II s core, and the occurrence of organ failure. Of the 126 patients with eclamps ia who were admitted to the ICU, records of 105 patients (83%) were found. The overall mortality was 10.5% (n = 11), The mean age, gestation, parity, number of preadmission seizures, and duration of stay were similar in survi vors and nonsurvivors. Although the APACHE II score was significantly highe r in nonsurvivors, multiple logistic regression analysis suggested that the goodness-of-fit scores for GCS and APACHE II were similar (38.29 vs. 38.01 ). The GCS scores of survivors were significantly higher than those of nons urvivors (10.61 vs. 5.0; p < .001), Respiratory failure was the most common organ failure in both groups. The mean number of organ failures was higher in nonsurvivors compared with survivors (2.9 vs. 1.3; p < .001), An occurr ence of more than two organ failures that persisted for >48 hrs was invaria bly associated with a fatal outcome. Anticonvulsant therapy consisted of ma gnesium sulfate or phenytoin and a midazolam infusion. Only one patient (0. 9%) had a seizure, and this occurred en route to the ICU. No seizures occur red after admission to the ICU, Conclusions: The organ system failure score and the GCS score are goad pred ictors of outcome in eclampsia. Apart from the GCS score, other variables i n the APACHE II score are not valuable for outcome prediction. The low GCS score in nonsurvivors suggests that closer attention to the neurologic mana gement may be beneficial. A prospective study is indicated to validate thes e findings.