Predictive validity of daily sequential organ failure assessment (SOFA)-2 score for 30-day mortality

Area of Science:

• Intensive care medicine
• Clinical epidemiology
• Health informatics

Background:

• The Sequential Organ Failure Assessment (SOFA) score is a key tool for assessing organ dysfunction in intensive care units (ICUs).
• Recent updates led to the development of SOFA-2, necessitating a comparison with the previous SOFA-1.
• Understanding the predictive performance of SOFA-2 is crucial for contemporary critical care practice.

Purpose of the Study:

• To compare the predictive validity of the updated SOFA-2 and the previous SOFA-1 for 30-day mortality.
• To evaluate performance over the first week in the ICU, considering overall patient populations and specific age/comorbidity subgroups.

Main Methods:

• A retrospective observational study included 29,820 adult ICU admissions in Sweden (2010-2021).
• Predictive validity for 30-day mortality was assessed using the area under the receiver operating characteristic curve (AUROC) from day 1 to day 7.
• Analyses were conducted overall and within subgroups defined by age and Charlson Comorbidity Index (CCI).

Main Results:

• SOFA-2 demonstrated a modestly higher AUROC (0.81) for 30-day mortality on ICU day 1 compared to SOFA-1 (0.80) (p < 0.001).
• AUROCs for both scores declined from day 2 onwards and showed largely similar performance.
• In specific subgroups like trauma patients, SOFA-2 showed good predictive validity (AUROC 0.81 on day 1), while sepsis patients had lower AUROCs (0.72 on day 1) for both scores.

Conclusions:

• SOFA-2 offers a slight improvement in discriminating 30-day mortality on the first day of ICU admission compared to SOFA-1.
• The predictive validity of both scores diminishes over the ICU stay and is influenced by patient age and comorbidity profiles.
• These findings highlight the context-dependent nature of organ dysfunction scoring in critical care settings.