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A z score (or standardized value) is measured in units of the standard deviation. It indicates how many standard deviations the value x is above (to the right of) or below (to the left of) the mean, μ. Values of x that are larger than the mean have positive z scores, and values of x that are smaller than the mean have negative z scores. If x equals the mean, then x has a zero z score. It is important to note that the mean of the z scores is zero, and the standard deviation is one.
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A z score (or standardized value) is measured in units of the standard deviation. It tells you how many standard deviations the value x is above (to the right of) or below (to the left of) the mean, μ. Values of x that are larger than the mean have positive z scores, and values of x that are smaller than the mean have negative z scores. If x equals the mean, then x has a zero z score. It is important to note that the mean of the z scores is zero, and the standard deviation is one.
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A new simplified and accurate sa-SOFA score.

Charles-Hervé Vacheron1, Arnaud Friggeri2, Jean Iwaz3

  • 1Département d'Anesthésie-Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, France; Université Claude Bernard - Lyon 1, Villeurbanne, France; Laboratoire de Biométrie et de Biologie Évolutive, Équipe Biostatistique-Santé, CNRS UMR 5558, Villeurbanne, France; Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France.

Journal of Critical Care
|January 14, 2020
PubMed
Summary

A new simplified Sequential Organ Failure Assessment (SOFA) score, the sa-SOFA, was developed. This sa-SOFA score demonstrated improved accuracy in predicting 28-day mortality for patients with Systemic Inflammatory Response Syndrome.

Keywords:
Intensive care unitsMortalityOrgan dysfunction scoresSOFA score

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Area of Science:

  • Critical Care Medicine
  • Clinical Scoring Systems
  • Prognostic Biomarkers

Background:

  • The Sequential Organ Failure Assessment (SOFA) score is widely used for assessing organ dysfunction and predicting mortality in critically ill patients.
  • Concerns exist regarding the complexity and optimal cut-points of the conventional SOFA score's variables.
  • A need for a simplified yet accurate prognostic tool for Systemic Inflammatory Response Syndrome (SIRS) patients is recognized.

Purpose of the Study:

  • To develop and validate a simplified and accurate scoring system, termed sa-SOFA, based on the SOFA score.
  • To identify the most relevant variables and optimal cut-points for predicting 28-day mortality in SIRS patients.
  • To compare the predictive performance of the new sa-SOFA score against the conventional SOFA score.

Main Methods:

  • Analysis of four prospective cohorts (2005-2016) including 1436 patients with SIRS.
  • Logistic regression and 10-fold cross-validation were employed to select key variables and determine optimal cut-points for the sa-SOFA score.
  • Receiver operating characteristic (ROC) curve analysis, specifically the area under the ROC curve (AUROC), was used to compare the predictive accuracy of sa-SOFA and SOFA.

Main Results:

  • The final sa-SOFA score retained one variable per dimension with two cut-points per variable.
  • The sa-SOFA score achieved a higher AUROC of 0.739 (95% CI: 0.712-0.768) for predicting 28-day mortality compared to the conventional SOFA score's AUROC of 0.687 (95% CI: 0.656-0.717).
  • The difference in predictive ability between sa-SOFA and SOFA was statistically significant (DeLong test p < 0.001).

Conclusions:

  • The developed sa-SOFA score is a simpler and more accurate tool for predicting 28-day mortality in SIRS patients.
  • The sa-SOFA score offers a potentially improved method for risk stratification in critical care settings.
  • Simplifying the SOFA score while maintaining its predictive power is feasible and beneficial for clinical application.