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Predictive Value of the Sequential Organ Failure Assessment Score for Mortality in a Contemporary Cardiac Intensive

Jacob C Jentzer1,2, Courtney Bennett3,2, Brandon M Wiley3,2

  • 1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN jentzer.jacob@mayo.edu.

Journal of the American Heart Association
|March 12, 2018
PubMed

Insights

The Sequential Organ Failure Assessment (SOFA) score effectively predicts short-term mortality in cardiac intensive care unit (CICU) patients, comparable to APACHE scores. Serial SOFA scores offer superior long-term mortality prediction and simplicity for risk stratification.

Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Medical Informatics

Background:

  • Mortality risk stratification in Cardiac Intensive Care Units (CICU) requires optimal methods.
  • The Sequential Organ Failure Assessment (SOFA) score's utility in predicting mortality in CICU patients is under investigation.

Purpose of the Study:

  • To evaluate the predictive accuracy of the SOFA score for mortality in a large, unselected CICU patient cohort.
  • To compare the SOFA score's performance against established scoring systems like APACHE-III and APACHE-IV.

Main Methods:

  • Retrospective review of 9961 adult CICU patients from 2007-2015.
  • Daily SOFA score calculation; APACHE-III and APACHE-IV scores calculated on CICU day 1.
  • Hospital mortality prediction assessed using receiver-operator characteristic (ROC) curves.

Main Results:

  • Day 1 SOFA score demonstrated good discrimination for hospital mortality (AUC 0.83), similar to APACHE-III and APACHE-IV.
  • Mean and maximum SOFA scores over multiple days showed significantly improved discrimination (P<0.01).
  • Increasing SOFA scores correlated with higher short-term and long-term mortality; SOFA <2 indicated low risk.

Conclusions:

  • The day 1 SOFA score reliably predicts short-term mortality in CICU patients, comparable to APACHE scores.
  • Serial SOFA scoring offers enhanced predictive power for both short-term and long-term mortality.
  • The SOFA score's simplicity and serial assessment capability present advantages for CICU risk stratification.
Abstract

Keywords:
Acute Physiology and Chronic Health Evaluation scoreSequential Organ Failure Assessment scorecardiac critical carecardiac intensive care unitcritical careintensive cardiac care unitintensive care unitmortalityrisk prediction

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