Mechanical Ventilation and Death During Pregnancy Complicated by COVID-19: A Prognostic Analysis from the Brazilian COVID-19 Registry Score
Authors: Reis Zilma Silveira Nogueira , de Aguiar Regina Amélia Lopes Pessoa , Sales Thaís Lorenna Souza , Maurílio Amanda de Oliveira , Scotton Ana Luiza Bahia Alves , Farace Bárbara Lopes , Ramos Carolina Marques , Cimini Christiane Corrêa Rodrigues , Cardoso Clareci Silva , Rempel Claudete , Ponce Daniela , Cezar Edilson , Kroger Emanuele Marianne Souza , Manenti Euler Roberto Fernandes , Aranha Felipe Ferraz Martins Graça , Anschau Fernando , Crestani Gabriela Petry , Bastos Gisele Alsina Nader , de Alvarenga Joice Coutinho , Machado-Rugolo Juliana , Ruschel Karen Brasil , Zandoná Liege Barella , Pinheiro Lílian Santos , Chiaravalle Luana Yasmin Bochard , Santos Luisa Elem Almeida , Floriani Maiara Anschau , Martins Matheus Fernandes Lopes , Júnior Milton Henriques Guimarães , Martelli Petrônio José de Lima , de Almeida Rafaela dos Santos Charão , Martins Raphael Castro , Pozza Roberta , Mourato Rodolfo Lucas Silva , Garbini Andresa Fontoura , Pires Magda Carvalho , Marcolino Milena Soriano 
Published: March 2022

Background
Assessing predictors of critical outcomes in COVID-19 may advise timely treatments and better prepare facilities to overcome extra adversities during pregnancy. However, many clinical parameters of existent scores are deeply modified by physiologic adaptations. Our aim was to assess the feasibility of a prognosis score developed for general hospitalized adults with COVID-19 in Brazil to predict clinical adverse outcomes in pregnant women upon hospital admission.
Methods
This is a multicenter retrospective substudy of the Brazilian COVID-19 Registry, a multicenter cohort analysis in Brazilian hospitals, which provided an accurate score to predict in-hospital death. The present analysis assessed the performance of this model, ABC2-SPH, based on data of 3978 patients, to assess poor clinical outcomes in data from 85 pregnant women admitted due to COVID-19 from March 1, 2020, to May 5, 2021, in 19 Brazilian hospitals. The primary outcomes were death and the composite mechanical ventilation or death, and secondary were pregnancy outcomes and severe/critical Covid-19. The overall discrimination of the model was presented as the area under the receiver operating characteristic curve (AUROC).
Results
Thirty-one (36.5%) pregnant women had critical or severe COVID-19. Most of them had no previous comorbidities (64.7%). The median gestational age was 31.0 (26.0, 36.2) weeks; 38 (44.7%) women gave birth during hospitalization by Covid-19, most of them by C-section (76.3%). The need for mechanical ventilation or death occurred in 14 (17.3%) pregnant women. Severe and critical COVID-19 in pregnant women was associated with diabetes, inflammatory markers, and abnormal vital signals observed at admission. The model was not able to identify adverse clinical outcomes. The AUROC of predicting severe/critical Covid-19 illness was 0.595 (95% CI: 0.424-0.754); AUROC of the inpatient death discrimination was 0.683 (95% CI: 0.293-0.945), as the AUROC of mechanical ventilation or death discrimination was 0.591 (95% CI: 0.434-0.75).
Conclusions
The model ABC2-SPH developed in Brazilian general patients was not able to identify adverse clinical outcomes in pregnant women with COVID-19. We warn against the use of general inpatients COVID-19 prognosis in pregnant women. A more useful model for clinical prognosis is necessary concerning the specificities of pregnancy affected by COVID-19.