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Improving the Accuracy of Cardiovascular Component of the Sequential Organ Failure Assessment Score
Hemang Yadav1, Andrew M Harrison, Andrew C Hanson
11Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. 2Department of Anesthesiology, Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, Rochester, MN. 3Mayo School of Graduate Medical Education, Medical Scientist Training Program, Mayo Clinic, Rochester, MN. 4Department of Anesthesiology, Mayo Clinic, Rochester, MN.
Insights
A modified Sequential Organ Failure Assessment (SOFA) score, incorporating current clinical practices and lactate levels, demonstrates superior accuracy in predicting patient mortality compared to the original SOFA score.
Area of Science:
- Critical Care Medicine
- Clinical Risk Prediction
- Sepsis and Septic Shock Management
Background:
- The Sequential Organ Failure Assessment (SOFA) score is a widely used tool for predicting patient outcomes in intensive care units (ICUs).
- The cardiovascular component of the SOFA score has become outdated due to advancements in clinical practice, particularly the use of various vasoactive agents.
- There is a need for an updated cardiovascular assessment within the SOFA score to accurately reflect current treatment protocols and improve risk stratification.
Purpose of the Study:
- To develop and validate a modified cardiovascular component for the SOFA score.
- To enhance the accuracy of the SOFA score in predicting patient mortality by incorporating contemporary clinical practices.
- To create a more reliable risk prediction model for ICU patients.
Main Methods:
- A retrospective cohort study was conducted involving adult patients admitted to six ICUs at Mayo Clinic.
- A modified cardiovascular SOFA score was developed, including all vasoactive agents, shock index, and serum lactate.
- Performance was evaluated using the area under the receiver operator characteristic curve (AUC) for in-ICU, in-hospital, and 28-day mortality.
Main Results:
- The modified cardiovascular SOFA score demonstrated significantly higher AUC values for predicting in-ICU, in-hospital, and 28-day mortality compared to the original cardiovascular SOFA score.
- In-ICU mortality: 0.801 (modified) vs 0.718 (original); In-hospital mortality: 0.783 vs 0.651; 28-day mortality: 0.737 vs 0.655.
- When integrated into the full SOFA score, the modified version consistently outperformed the existing SOFA score across all mortality endpoints in both derivation and validation cohorts.
Conclusions:
- The modified cardiovascular SOFA score is a more accurate predictor of patient outcomes than the original cardiovascular SOFA score.
- This enhanced score improves the overall predictive performance of the SOFA model, reflecting current clinical practices.
- The modified score is easily calculable and incorporates crucial biomarkers like serum lactate and comprehensive vasoactive agent use.
Objectives:
The Sequential Organ Failure Assessment score is an attractive risk prediction model because of its simplicity and graded assessment of morbidity and mortality. Due to changes in clinical practice over time, the cardiovascular component of the Sequential Organ Failure Assessment score no longer accurately reflects current clinical practice. To address this limitation, we developed and validated a modified cardiovascular component of the Sequential Organ Failure Assessment score that takes into account all vasoactive agents used in current clinical practice, uses shock index as a substitute for mean arterial pressure, and incorporates serum lactate as a biomarker for shock states.
Design:
Retrospective cohort.
Setting:
Mayo Clinic, Rochester, MN.
Patients:
Adult patients admitted to one of six ICUs.
Interventions:
None.
Measurements And Main Results:
Score performance was assessed via area under the receiver operator characteristic curve. A total of 16,386 ICU admissions were included: 9,204 in the derivation cohort and 7,182 in the validation cohort. area under the receiver operator characteristic curve was significantly higher for modified cardiovascular component of the Sequential Organ Failure Assessment score than for cardiovascular component of the Sequential Organ Failure Assessment for in-ICU mortality (0.801 vs 0.718; difference = 0.083; p < 0.001), in-hospital mortality (0.783 vs 0.651; difference = 0.132; p < 0.001), and 28-day mortality (0.737 vs 0.655; difference = 0.082; p < 0.001). When modified cardiovascular component of the Sequential Organ Failure Assessment score was added to the remaining Sequential Organ Failure Assessment components, the modified Sequential Organ Failure Assessment score again outperformed the existing Sequential Organ Failure Assessment score: in-ICU mortality (0.836 vs 0.822; difference = 0.014; p < 0.001), in-hospital mortality (0.799 vs 0.784; difference = 0.015; p < 0.001), and 28-day mortality (0.798 vs 0.783; difference = 0.015; p < 0.001). Similar results were seen in the validation cohort.
Conclusions:
The modified cardiovascular component of the Sequential Organ Failure Assessment score outperforms the existing cardiovascular component of the Sequential Organ Failure Assessment score in predicting patient outcomes and improves the overall performance of the Sequential Organ Failure Assessment model. This score is easily calculated, includes serum lactate as a biomarker for shock states, and incorporates all vasopressors used in current clinical practice.
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