The SOFA score as a mortality predictor in ICU patients: insights from a tertiary care hospital in Pakistan

In recent years, significant advancements have been made in developing models to assess the severity of illness and predict mortality in critically ill patients. Effective outcome prediction requires accurate data on the severity of disease and the associated risk of death. The Sequential Organ Failure Assessment (SOFA) score is a widely used, objective tool that quantifies the severity of organ dysfunction and its impact on patient outcomes. The main purpose of this study was to investigate the predictive factors of mortality among patients admitted to the ICU.

This descriptive case series study was conducted over six months at the Department of Medicine, Abbasi Shaheed Hospital, Karachi, to examine ICU patient mortality and compare rates between patients with SOFA scores. A non-probability consecutive sampling method was used, with 172 patients enrolled. The sample size was calculated using the WHO calculator, assuming a 32.6% mortality rate and a 7% margin of error. Univariate and multivariate logistic regression were used to assess the associations between variables and mortality, with odds ratios (ORs) and 95% confidence intervals (CIs) reported.

A total of 172 patients were included in the analysis, with a mean age of 57.21 ± 6.24 years. Multivariate logistic regression demonstrated that both age and SOFA score were independent predictors of mortality. For each one-point increase in the SOFA score, the odds of survival decreased by 13% (OR = 0.87, 95% CI: 0.81-0.93, p < 0.001), indicating that higher organ dysfunction, as reflected by the SOFA score, was associated with a significantly increased risk of death. Age was also a significant factor, with each additional year of age elevating the odds of mortality by 2% (OR = 1.02, 95% CI: 1.00-1.04, p = 0.02), suggesting that older patients faced a higher risk of mortality. Furthermore, individuals with a BMI ≥ 30 kg/m² exhibited more than twice the odds of mortality compared to those with lower BMI (OR = 2.05, 95% CI: 1.03-4.18, p = 0.04), indicating that obesity may contribute to poorer outcomes in critically ill patients.

The SOFA score, age, and BMI are independent predictors of mortality in ICU patients. The SOFA score continues to be a strong indicator of patient prognosis, with higher scores linked to increased mortality risk due to greater organ dysfunction. Older age also significantly raises the likelihood of death, while obesity (BMI ≥ 30 kg/m²) seems to further increase the risk of mortality. These findings imply that early recognition of these factors can help inform clinical decisions and improve patient outcomes in ICU settings, especially in low- to middle-income countries.