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Sequential Organ Failure Assessment Score in the ICU As a Predictor of Long-Term Survival After Cardiac Surgery
Tiago R Velho1,2, Rafael Maniés Pereira1, Tiago Paixão3
1Cardiothoracic Surgery Department, Hospital de Santa Maria-CHLN, Lisboa, Portugal.
Insights
The Sequential Organ Failure Assessment (SOFA) score after cardiac surgery predicts long-term survival. Lower SOFA scores at 48 hours indicate better outcomes, aiding in patient risk stratification for mortality.
Area of Science:
- Critical Care Medicine
- Cardiac Surgery Outcomes
- Predictive Analytics in Healthcare
Background:
- The Sequential Organ Failure Assessment (SOFA) score is a standard mortality predictor in intensive care units (ICUs).
- While validated for short-term outcomes in cardiac ICUs, its correlation with long-term survival post-cardiac surgery remains less explored.
- Early postoperative SOFA scores require further investigation for their prognostic value in long-term patient survival.
Purpose of the Study:
- To investigate the association between early postoperative Sequential Organ Failure Assessment (SOFA) scores and long-term survival (12 and 24 months) in patients undergoing cardiac surgery.
- To determine which SOFA score metrics (e.g., at 24h, 48h, mean, highest) are most accurate in predicting long-term mortality.
- To assess the predictive accuracy of SOFA score variation within the first 48 hours post-surgery.
Main Methods:
- Retrospective observational cohort study including 1,379 patients from a tertiary academic cardiac surgery ICU.
- SOFA scores at 24 hours, 48 hours, mean, and highest values were collected and analyzed.
- Statistical analyses included Wilcoxon tests, multivariate logistic regressions, and receiver operating characteristic (ROC) curves to evaluate predictive performance.
Main Results:
- Lower SOFA scores were significantly associated with improved survival rates at both 12 and 24 months post-surgery.
- The highest SOFA score and SOFA score at 48 hours demonstrated superior accuracy in predicting outcomes compared to initial or mean SOFA scores.
- A decreasing SOFA score within 48 hours correlated with a 4.9% mortality rate, versus 5.7% for unchanged or increased scores.
Conclusions:
- The SOFA score obtained in the ICU following cardiac surgery is a valuable predictor of long-term survival.
- Absolute SOFA values at 48 hours post-surgery are more strongly correlated with 12-month survival than score variations.
- The SOFA score can effectively stratify cardiac surgery patients based on their risk of long-term mortality.
Objectives:
The Sequential Organ Failure Assessment (SOFA) score is a predictor of mortality in ICU patients. Although it is widely used and has been validated as a reliable and independent predictor of mortality and morbidity in cardiac ICU, few studies correlate early postoperative SOFA with long-term survival.
Design:
Retrospective observational cohort study.
Setting:
Tertiary academic cardiac surgery ICU.
Patients:
One-thousand three-hundred seventy-nine patients submitted to cardiac surgery.
Interventions:
SOFA 24 hours, SOFA 48 hours, mean, and highest SOFA scores were correlated with survival at 12 and 24 months. Wilcoxon tests were used to analyze differences in variables. Multivariate logistic regressions and likelihood ratio test were used to access the predictive modeling. Receiver operating characteristic curves were used to assess accuracy of the variables in separating survivor from nonsurvivors.
Measurements And Main Results:
Lower SOFA scores have better survival rates at 12 and 24 months. Highest SOFA and SOFA at 48 hours showed to be better predictors of outcome and to have higher accuracy in distinguishing survivors from nonsurvivors than initial SOFA and mean SOFA. A decreasing score during the first 48 hours had mortality rates of 4.9%, while an unchanged or increased score was associated with a mortality rate of 5.7%.
Conclusions:
SOFA score in the ICU after cardiac surgery correlated with survival at 12 and 24 months. Patients with lower SOFA scores had higher survival rates. Differences in survival at 12 months were better correlated with the absolute value at 48 hours than with its variation. SOFA score may be useful to predict long-term outcomes and to stratify patients with higher probability of mortality.
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