Association of Sequential Organ Failure Assessment (SOFA) components with mortality

Area of Science:

• Critical Care Medicine
• Clinical Epidemiology
• Health Services Research

Background:

• The Sequential Organ Failure Assessment (SOFA) score quantifies organ dysfunction severity.
• SOFA is proposed as a clinical trial endpoint, requiring comparable component severity.
• Investigating SOFA component associations with mortality is crucial for trial endpoint justification.

Purpose of the Study:

• To assess if different SOFA component scores correlate comparably with in-hospital mortality.
• To evaluate the relative severity of organ dysfunctions as indicated by SOFA scores.

Main Methods:

• Nationwide register data from 26 Finnish ICUs (2012-2015) analyzed.
• SOFA score determined as maximum within 24 hours of ICU admission.
• Organ failure defined as SOFA score ≥3; associations with mortality evaluated.

Main Results:

• Study included 63,756 ICU patients; overall hospital mortality was 10.7%.
• Mortality varied significantly by organ failure type (e.g., hepatic 40.1%, cardiovascular 14.9%).
• Patients with cardiovascular organ failure had lower mortality risk than others with similar total SOFA scores.

Conclusions:

• All SOFA components correlate with mortality, but their weighting is unequal.
• High cardiovascular SOFA scores indicate a lower mortality risk compared to other organ systems.
• The current SOFA scoring for cardiovascular dysfunction requires revision to improve accuracy.