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Variation of the SOFA score and mortality in patients with severe burns: A cohort study
Julien Calles1, Benjamin Cohen1, Nathalie Forme2
1Anaesthesia and Critical Care Department, Tours University Hospital, Tours, France.
Abstract:
Multiple organ failure (MOF) is the leading cause of death in patients with burns requiring ICU admission. Quantifying the evolution of MOF, with the SOFA score, over the first few days after a severe burn may provide useful prognostic information. This retrospective cohort study aimed at evaluating the association between the evolution of the SOFA score between day 0 and day 3 and in-hospital mortality. All patients admitted for severe burns at the burn ICU of the Tours University Hospital between 2017 and 2020 and who stayed 3 days or more were included. Severe burns included: total body surface area burned (TBSA) ≥ 20 % or burns of any surface associated with one or more of the following items: (1) organ failure, (2) clinically significant smoke inhalation and/or cyanide poisoning, (3) severe preexisting comorbidities, (4) complex and specialized burn wound care. DeltaSOFA was defined as day 3 minus day 0 SOFA. One hundred and thirty-six patients were included. Median age was 52 years (38-70), median TBSA burned was 24 % (20-38), median day 0 SOFA was 2 (0-4) and median day 3 SOFA was 1 (0-5). In-hospital mortality was 10 %. There was a significant association between deltaSOFA and mortality that persisted after adjustment for age and TBSA (HR 1.37, 95 %CI 1.09-1.72, p < 0.01). Area under the receiver operating characteristics curve for the prediction of mortality by day 0 SOFA and deltaSOFA were 0.79 (95 %CI 0.69-0.89) and 0.83 (95 %CI 0.70-0.95) respectively. After exclusion of patients with TBSA burned< 15 %, deltaSOFA remained independently associated with mortality (HR 1.42 95 %CI 1.09-1.85, p < 0.01). In addition, SOFA variations allowed the identification of subgroups of patients with either very low or very high mortality. In patients with severe burns, SOFA score evolution between day 0 and day 3 may be useful for individualized medical and ethical decisions. Further multicenter studies are required to corroborate the present results.
Insights
The evolution of the Sequential Organ Failure Assessment (SOFA) score in severe burn patients from day 0 to day 3 is a significant predictor of in-hospital mortality. This score change helps identify high-risk patients for tailored care.
Area of Science:
- Critical Care Medicine
- Burn Surgery
- Trauma Surgery
Background:
- Multiple organ failure (MOF) is the primary cause of death in severe burn patients admitted to the ICU.
- The Sequential Organ Failure Assessment (SOFA) score quantifies organ dysfunction.
Purpose of the Study:
- To evaluate the association between the change in SOFA score (DeltaSOFA) from day 0 to day 3 and in-hospital mortality in severe burn patients.
- To determine if DeltaSOFA provides prognostic information for predicting mortality.
Main Methods:
- Retrospective cohort study including 136 severe burn patients admitted between 2017 and 2020.
- Severe burns defined by Total Body Surface Area (TBSA) ≥ 20% or other critical factors.
- DeltaSOFA calculated as the difference between day 3 and day 0 SOFA scores.
Main Results:
- In-hospital mortality was 10%.
- A significant association was found between DeltaSOFA and mortality, persisting after adjustment for age and TBSA (HR 1.37).
- DeltaSOFA showed a high predictive value for mortality (AUC 0.83), outperforming day 0 SOFA (AUC 0.79).
Conclusions:
- SOFA score evolution between day 0 and day 3 is an independent predictor of mortality in severe burn patients.
- DeltaSOFA can identify patient subgroups with varying mortality risks, aiding in individualized treatment decisions.
- Further multicenter studies are needed to confirm these findings.
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