Association between base deficit and adverse outcomes in critically ill obstetric patients with severe preeclampsia: A multicenter retrospective cohort study.

OBJECTIVE

This study explored the associations between base deficit levels at intensive care unit admission and severe maternal outcomes in patients with severe preeclampsia.

STUDY

DESIGN

This observational, retrospective cohort study included patients with severe preeclampsia admitted to intensive care units across five different centers in Colombia.

MAIN OUTCOME MEASURES: Base deficit at intensive care admission was evaluated as a predictor of a composite severe maternal outcome (mechanical ventilation, transfusion, or death). Logistic regression models, with and without interaction terms, were used to assess the associations. Postestimation marginal effects were calculated, and predictive performance was compared with that of other biomarkers.

RESULTS

Among the 1,000 patients with severe preeclampsia, 229 (22.9%) experienced the outcome. Markers of organ dysfunction and maternal complications increased progressively across different levels of base deficit. A base deficit >10 mmol/L was strongly linked to severe maternal outcomes (OR: 7.16; 95% CI: 3.94-12.98), as were a creatinine level >1.1 mg/dL (OR: 5.88; 95% CI: 3.93-8.80), lactate dehydrogenase level ≥600 U/L (OR: 4.45; 95% CI: 3.13-6.34), and a platelet count <50 × 109/L (OR: 7.78; 95% CI: 4.70-12.89). Multivariable analysis confirmed that base deficit is an independent predictor, with better model fit when interaction is included. Marginal effects analysis revealed that this likelihood increases as base deficit becomes more negative, particularly when combined with thrombocytopenia (≤50,000/μL), elevated creatinine (>1.1 mg/dL), or increased lactate dehydrogenase (≥600 U/L).

CONCLUSION

Base deficit is a valuable marker for identifying progression to severe maternal outcomes in critically ill patients with preeclampsia.