Variation in SOFA (Sequential Organ Failure Assessment) Score Performance in Different Infectious States

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Epidemiology

Background:

• The Sequential Organ Failure Assessment (SOFA) score is widely used for prognostication in intensive care units (ICUs).
• Its performance may vary depending on the underlying cause of organ dysfunction, such as different types of infection.
• Understanding these variations is crucial for accurate patient assessment and management.

Purpose of the Study:

• To evaluate whether the performance of the SOFA score in predicting mortality differs across various infection types in ICU patients.
• To compare the discriminative ability of the SOFA score for mortality based on specific infections.

Main Methods:

• A retrospective study was conducted on adult ICU patients admitted with infection between 2008 and 2018.
• Patients were categorized into distinct infection types (e.g., pneumonia, UTI, bacteremia) using ICD codes.
• SOFA score performance and in-hospital mortality were analyzed across these infection groups.

Main Results:

• The study included 12,283 patients; pneumonia and urinary tract infections (UTIs) were most common.
• SOFA score performance varied significantly by infection type, with the highest mortality prediction for endocarditis (AUC: 0.79) and lowest for isolated bacteremia (AUC: 0.59).
• Median SOFA scores differed, with peritonitis patients having the highest and cellulitis/UTI patients having the lowest.

Conclusions:

• The type of infection significantly influences the interpretation and performance of the SOFA score.
• These findings highlight the importance of considering infection-specific factors when using SOFA for sepsis definition and prognostication.
• Tailoring score interpretation to infection type may improve clinical decision-making in ICUs.