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Background <p>Chorioamnionitis is a known independent risk factor for early-onset sepsis (EOS) in infants. In 2015, the term was redefined as “intrauterine inflammation or infection or both” (Triple-I) to improve clinical management of maternal and neonatal infections. This study evaluated the association between the Kaiser sepsis score (KSS), a tool for predicting and managing EOS in newborns, and histopathologic chorioamnionitis (HCA) and confirmed Triple-I.</p> Methods <p>This retrospective cohort study included mother-infant dyads with a gestational age of ≥ 34 weeks at birth, delivered between January 2014 and December 2019, with a maternal diagnosis of clinical chorioamnionitis. Receiver operating characteristic (ROC) curves were used to assess the association between the KSS, Triple-I, and HCA.</p> Results <p>A total of 230 mother-infant dyads were analyzed, of whom 157 (68.2%) had HCA and 86 (37.3%) had confirmed Triple-I. Infant demographic characteristics were comparable between groups, except for the KSS, which was significantly higher in the Triple-I group [1.22 vs. 0.83, <i>p</i> &lt; 0.001; OR 1.21, 95% CI 1.04–1.4]. The KSS demonstrated a strong positive association with confirmed Triple-I (AUC 0.77, 95% CI 0.71–0.83), while its association with HCA was weaker (AUC 0.59, 95% CI 0.51–0.67). At the same KSS threshold, sensitivity for diagnosing Triple-I was higher than for HCA.</p> Conclusion <p>KSS showed a stronger association with confirmed Triple-I compared to HCA in mothers with clinical chorioamnionitis, suggesting that Triple-I is a better predictor of EOS risk.</p>

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Association of Kaiser sepsis score with confirmed intrauterine infection and inflammation (Triple-I) in clinical chorioamnionitis: a retrospective cohort study

  • 期刊论文

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  • 发表日期：

    2025年10月3日

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  • Sophia Rafferty,
  • Amy Heerema-McKenney,
  • Melanie Kasaris,
  • Amanda Smith,
  • Gloria Gordon-Ocejo,
  • Hany Aly,
  • Anirudha Das

摘要

Background

Chorioamnionitis is a known independent risk factor for early-onset sepsis (EOS) in infants. In 2015, the term was redefined as “intrauterine inflammation or infection or both” (Triple-I) to improve clinical management of maternal and neonatal infections. This study evaluated the association between the Kaiser sepsis score (KSS), a tool for predicting and managing EOS in newborns, and histopathologic chorioamnionitis (HCA) and confirmed Triple-I.

Methods

This retrospective cohort study included mother-infant dyads with a gestational age of ≥ 34 weeks at birth, delivered between January 2014 and December 2019, with a maternal diagnosis of clinical chorioamnionitis. Receiver operating characteristic (ROC) curves were used to assess the association between the KSS, Triple-I, and HCA.

Results

A total of 230 mother-infant dyads were analyzed, of whom 157 (68.2%) had HCA and 86 (37.3%) had confirmed Triple-I. Infant demographic characteristics were comparable between groups, except for the KSS, which was significantly higher in the Triple-I group [1.22 vs. 0.83, p < 0.001; OR 1.21, 95% CI 1.04–1.4]. The KSS demonstrated a strong positive association with confirmed Triple-I (AUC 0.77, 95% CI 0.71–0.83), while its association with HCA was weaker (AUC 0.59, 95% CI 0.51–0.67). At the same KSS threshold, sensitivity for diagnosing Triple-I was higher than for HCA.

Conclusion

KSS showed a stronger association with confirmed Triple-I compared to HCA in mothers with clinical chorioamnionitis, suggesting that Triple-I is a better predictor of EOS risk.