When pregnant women get COVID-19 infection, they are twice as likely as their non-pregnant peers to require critical care or mechanical ventilation. However, there are no prediction models for critical COVID-19 infection and intensive care unit admission in symptomatic pregnant women.
full-COMIT and mini-COMIT (COvid Maternal Intensive Therapy models)
Both the ‘full-COMIT’ and ‘mini-COMIT’ models were developed and internally validated in a cohort of 793 pregnant women who were positive for SARS-CoV-2 and symptomatic, in the UK, Austria, Turkey, and Greece. The risk of critical COVID-19 is this cohort was 5.5%, and 1.3% of women died.
The ‘mini-COMIT’ model for less-resourced settings includes maternal age, body-mass index and diagnosis in the third trimester of pregnancy. Women with a risk of critical COVID-19 of at least 10% warrant close monitoring.
The ‘full-COMIT model for well-resourced settings includes maternal body-mass index, lower respiratory tract symptoms, neutrophil/lymphocyte ratio, and serum C-reactive protein. Women with a critical COVID-19 risk <5% can be reassured that progression to severe COVID-19 is very unlikely, and those with a critical COVID-19 risk of at least 5% warrant close monitoring.
Also, the models identify women with a shorter diagnosis to intensive care unit admission interval, and higher risk of maternal death or preeclampsia.
Each model has good stratification capacity and predictive performance (AUC ROC: 0.85 for ‘full-COMIT’ and 0.73 for ‘mini-COMIT’),
Why would I need to use these prediction models?
We need to quantify the risk of progression to critical COVID-19 in pregnant women with symptomatic infection. While full-COMIT and mini-COMIT should be validated externally in other datasets, we offer these models now during the pandemic to facilitate evidence-based triage and effective targeting of diagnostic and therapeutic interventions, including place of care, thereby focusing healthcare resources on women in greatest need.