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Multicenter International Cohort Validation of a Modified Sequential Organ Failure Assessment Score Using the
Shayan Rakhit1,2,3, Li Wang1,4, Christopher J Lindsell4
1Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN.
Annals of Surgery
|November 17, 2020
Summary
A modified Sequential Organ Failure Assessment (mSOFA) using the Richmond Agitation-Sedation Scale (RASS) effectively predicts intensive care unit (ICU) mortality, comparable to the traditional Glasgow Coma Scale (GCS)-based SOFA. This validates RASS as a viable alternative for neurologic assessment in critical care scoring systems.
Area of Science:
- Critical Care Medicine
- Clinical Epidemiology
- Health Outcomes Research
Background:
- The Sequential Organ Failure Assessment (SOFA) score, utilizing the Glasgow Coma Scale (GCS) for its neurologic component, is a key predictor of intensive care unit (ICU) mortality.
- GCS is frequently unavailable, with the Richmond Agitation-Sedation Scale (RASS) often used as a reliable alternative.
- Previous single-center studies suggested that an RASS-based SOFA (mSOFA) could predict ICU mortality.
Purpose of the Study:
- To validate a modified SOFA (mSOFA) score using RASS in a large, international cohort.
- To assess if mSOFA, derived from RASS, demonstrates comparable predictive accuracy for ICU mortality to the traditional GCS-based SOFA.
Main Methods:
- A nested cohort of 4120 mechanically ventilated patients from the 2016 Fourth International Study of Mechanical Ventilation was analyzed.
- GCS was estimated from RASS using a proportional odds model. Both SOFA (using measured GCS) and mSOFA (using RASS-estimated GCS) were constructed.
- Logistic regression models and c-statistics were used to compare the predictive performance of SOFA and mSOFA for ICU mortality, adjusted for covariates.
Main Results:
- The study included 4120 patients across 32 countries, with a mean ICU mortality of 31%.
- Both SOFA (AUC = 0.784) and mSOFA (AUC = 0.778) demonstrated similar and strong predictive capabilities for ICU mortality (P = 0.139).
- Higher age, female sex, medical patient status, and African region were independently associated with increased mortality.
Conclusions:
- This study presents the first international validation of an RASS-based SOFA modification (mSOFA) in a real-world setting.
- Estimating GCS from RASS maintains the predictive validity of the SOFA score for ICU mortality.
- Alternative neurologic assessments like RASS can be effectively integrated into critical care severity scoring systems.
