Serial SOFA-score trends in ICU-admitted COVID-19 patients as predictor of 28-day mortality: A prospective cohort study
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Published on: January 16, 2019
Farzad Esmaeili Tarki1, Siamak Afaghi2, Fatemeh Sadat Rahimi3
1Research Department of Internal Medicine Shahid Beheshti University of Medical Sciences Tehran Iran.
Background And Aim:
The efficacy of Sequential Organ Failure Assessment (SOFA) score as predictor of clinical outcomes among ICU-admitted COVID-19 patients is still controversial. We aimed to assess whether SOFA-score in different time intervals could predict 28-day mortality compared with other well-acknowledged risk factors of COVID-19 mortality.
Methods:
This observational prospective cohort was conducted on 1057 patients from March 2020 to March 2022 at Masih Daneshvari Hospital, Iran. The univariate and multivariate Cox proportional analysis were performed to assess the hazards of SOFA-score models. Receiver operating characteristic (ROC) curves were designed to estimate the predictive values.
Results:
Mean SOFA-score during first 96 h (HR: 3.82 [CI: 2.75-5.31]), highest SOFA-score (HR: 2.70 [CI: 1.93-3.78]), and initial SOFA-score (HR: 1.65 [CI: 1.30-2.11]) had strongest association with 28-day mortality (p < .0001). In contrast, SOFA scores at 48 and 96 h as well as Δ-SOFA: 48-0 h and Δ-SOFA: 96-0 h did not show significant correlations. Among them, merely mean SOFA-score (HR: 2.28 [CI: 2.21-3.51]; p < .001) remained as independent prognosticator on multivariate regression analysis; though having less odds of predicting value compared with age (HR: 3.81 [CI: 1.98-5.21]), hypertension (HR: 3.11 [CI: 1.26-3.81]), coronary artery disease [CAD] (HR: 2.82 [CI: 1.51-4.8]), and diabetes mellitus (HR: 2.45 [CI: 1.36-2.99]). The area under ROC (AUROC) for mean SOFA-score (0.77) and highest SOFA-score (0.71) were larger than other SOFA intervals. Calculating the first 96 h of SOFA trends, it was obtained that fatality rate was <12.3% if the score dropped, between 28.8% and 46.29% if the score remained unchanged, and >50.45% if the score increased.
Conclusion:
To predict the 28-day mortality among ICU-admitted COVID-19 patients, mean SOFA upon first 96 h of ICU stay is reliable; while having inadequate accuracy comparing with well-acknowledged COVID-19 mortality predictors (age, diabetes mellitus, hypertension, CAD). Notably, increased SOFA levels in the course of first 96 h of ICU-admission, prognosticate at least 50% fatality regardless of initial SOFA score.
Insights
The Sequential Organ Failure Assessment (SOFA) score, particularly the mean score within the first 96 hours, can predict 28-day mortality in ICU COVID-19 patients. However, it is less accurate than established factors like age and comorbidities.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Epidemiology
Background:
- The predictive value of the Sequential Organ Failure Assessment (SOFA) score for clinical outcomes in ICU-admitted COVID-19 patients remains debated.
- This study investigates the SOFA score's efficacy in predicting 28-day mortality compared to established COVID-19 risk factors.
Purpose of the Study:
- To assess the predictive capability of SOFA scores at various time points for 28-day mortality in COVID-19 patients admitted to the ICU.
- To compare the predictive accuracy of SOFA scores with well-recognized risk factors for COVID-19 mortality.
Main Methods:
- An observational prospective cohort study included 1057 patients from March 2020 to March 2022.
- Univariate and multivariate Cox proportional analyses were used to evaluate SOFA score models.
- Receiver operating characteristic (ROC) curves were employed to determine predictive values.
Main Results:
- Mean SOFA score within the first 96 hours (HR: 3.82), highest SOFA score (HR: 2.70), and initial SOFA score (HR: 1.65) showed significant association with 28-day mortality (p < .0001).
- Mean SOFA score remained an independent prognosticator (HR: 2.28) but had lower predictive value than age, hypertension, coronary artery disease (CAD), and diabetes mellitus.
- The area under the ROC curve was highest for mean SOFA score (0.77) and highest SOFA score (0.71). An increasing SOFA trend within 96 hours predicted >50% fatality.
Conclusions:
- The mean SOFA score within the first 96 hours of ICU stay is a reliable predictor of 28-day mortality in COVID-19 patients.
- However, its accuracy is inferior to established predictors like age, diabetes mellitus, hypertension, and CAD.
- An increasing SOFA score trend during the initial 96 ICU hours indicates a high fatality rate, irrespective of the initial score.
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