• Daniela N Vasquez, Andrea V Das Neves, Vanina B Aphalo, Cecilia I Loudet, Javier Roberti, Federico Cicora, Matias Casanova, Hector S Canales, Alfredo D Intile, Jose L Scapellato, Pablo M Desmery, and Elisa Estenssoro.
• Hospital Interzonal General de Agudos Gral. San Martín, La Plata, Buenos Aires, Argentina; Sanatorio Anchorena, City of Buenos Aires, Argentina; Fundación para la Investigación y Asistencia de la Enfermedad Renal, La Plata, Buenos Aires, Argentina. Electronic address: daniela.vasquez@alumni.utoronto.ca.
• J Crit Care. 2014 Apr 1;29(2):199-203.

PurposeIn Argentina, uninsured patients receive public health care, and the insured receive private health care. Our aim was to compare different outcomes between critically ill obstetric patients from both sectors.MethodsThis is a prospective cohort, including pregnant/postpartum patients requiring admission to 1 intensive care unit in the public sector (uninsured) and 1 in the private (insured) from January 1, 2008, to September 30, 2011.ResultsA total of 151 patients were included in the study. In uninsured (n = 63) vs insured (n = 88) patients, Acute Physiology and Chronic Evaluation II (APACHE II) and Sequential Organ Failure Assessment scores were 11 ± 6.5 vs 8 ± 4 and 3 (2-7) vs 1 (0-2), respectively, and 84% vs 100% received prenatal care (P = .001 for all). Multiple organ dysfunction syndrome (MODS) was present in 32 (54%) uninsured vs 9 (10%) insured patients (P = .001), and acute respiratory distress syndrome developed in 18 (30.5%) of 59 vs 2(2%) of 88 (P = .001). Neonatal survival was 80% vs 96% (P = .003). Variables independently associated with the development of MODS were APACHE II (odds ratio, 1.30 [1.13-1.49]), referral from another hospital (odds ratio, 11.43 [1.86-70.20]), lack of health insurance (odds ratio 6.75 [2.17-20.09]), and shock (odds ratio 4.82 [1.54-15.06]). Three patients died, all uninsured.ConclusionsUninsured critically ill obstetric patients (public sector) were more severely ill on admission and experienced worse outcomes than insured patients (private sector). Variables independently associated with MODS were APACHE II, shock, referral from another hospital, and lack of insurance.Copyright © 2014 Elsevier Inc. All rights reserved.

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