Original article
Serial evaluation of SOFA score in a Brazilian teaching hospital

https://doi.org/10.1016/j.iccn.2009.10.005Get rights and content

Summary

Objectives

To evaluate the application of the Sequential Organ Failure Assessment (SOFA) in describing the severity of organ dysfunctions and the associated mortality rates in critically ill patients at a teaching hospital.

Research methodology

Prospective longitudinal study performed in 1164 adult, critically ill patients who were admitted consecutively into intensive care units between January 2004 and December 2005. We analysed static evaluation of SOFA and dynamic changes in the SOFA scores. The discriminative power of SOFA was evaluated using ROC curves.

Results

There was an increase in the mortality rate when the SOFA scores increased (χtrend2=272.08, p < 0.001, increase rate = 0.13). The SOFA score on the third day in the ICU had the highest area under the curve for hospital mortality (AUC: 0.817 ± 0.0133, CI 95%: 0.792–0.840). We analysed SOFA score changes with time and observed that patients with low scores (0–5) upon admission and who increased to the medium or high SOFA groups had a significantly higher mortality rate (51.7 and 100%, respectively, p < 0.001).

Conclusions

Applying SOFA to critically ill patients effectively described the severity of organ dysfunctions, and higher SOFA scores had a positive association with mortality.

Introduction

Organ dysfunction can occur while managing critically ill patients and is considered the main cause of morbidity and mortality in intensive care units (ICUs) (Marshall, 2001). Several scores have been designed to evaluate organ dysfunction, including the Brussels Score, the Multiple Organ Dysfunction Score (MODS), the Logistic Organ Dysfunction Score (LODS) and the Sequential Organ Failure Assessment (SOFA) score (Cabré et al., 2005, Pettilä et al., 2002). These systems have been applied to define resource allocation and to monitor and compare ICU performance (Bueno et al., 2005, Lavigne de Lemos et al., 2005).

SOFA was developed by Vincent et al. (1996) during a consensus meeting, and validated in a study involving 40 ICUs from 16 countries (Antonelli et al., 1999). SOFA provides a continuous evaluation of organ dysfunction by considering variations in six, easily reproducible variables that measure illness severity during ICU stays (Vincent et al., 1998). This allows for early detection of organ dysfunction and therapy to prevent additional organ dysfunction. SOFA was developed to describe the degree and severity of organ dysfunction, but was not originally intended to predict the risk of death. However, previous studies have reported a correlation between the severity of organ dysfunction and death (Asthutosh et al., 2007, Chen et al., 2005, Pettilä et al., 2002).

The performance of a score must be evaluated in different groups of patients before it is implemented into common use (Janssens et al., 2000, Rocco et al., 2005). The aim of the present study was to evaluate the performance of SOFA score for description of severity of organ dysfunction and prediction of mortality in critically ill patients in a teaching hospital.

Section snippets

Setting

Longitudinal prospective study of critically ill patients admitted to the adult ICU of the University Hospital at Londrina State University. The ICU at Londrina University Hospital is a mixed unit with 17 adult surgical-medical beds with a mean occupancy rate over 85%.

Sample

All consecutively admitted patients to the ICU obtained from January 1, 2004 to December 31, 2005. Exclusion criteria were readmission, transfer to other units, ICU stay length under 24 hours and patients aged less than 18 years.

Data collection

Results

During the study period, 1694 patients were admitted to the ICU. Of this total, 346 were excluded from the study because their stay in the ICU was less than the 24-hour criteria, 109 were excluded because of readmission, 38 patients were excluded for being under 18 years of age, 15 were transferred to another ICU and 22 had insufficient data. Therefore, the study sample included 1164 patients. The original admission location was the emergency department for 47.5% of the cases, 22.3% came from

Discussion

Organ dysfunction scores are routinely applied in ICU and are important tools for managing critically ill patients. SOFA is globally used and has been validated in other populations and clinical settings (Antonelli et al., 1999, Ceriani et al., 2003, Hynninem et al., 2008, Janssens et al., 2000). SOFA monitors organ dysfunction as a continuous process and temporal evaluation allows a better understanding of illness process, and quantifies the dysfunction of individual organs which justifies the

Conclusions

In conclusion, SOFA effectively described severity of organ failures and dysfunctions in our patients. High SOFA scores were positively associated with mortality. Our patients showed high frequency of organ dysfunctions, particularly in respiratory and cardiovascular systems. SOFA scores were higher in non-survivors than in survivors. Dynamic evaluation of SOFA proved to be an effective prognostic predictor and a reliable marker of illness severity.

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