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Predictive validity of SOFA-2 score for In-Hospital Mortality Among Patients With Suspected Infection Presenting to
Chieh-Ching Yen1, Shang-Jun ZhangJian2, Ma Cheng-Yu3
1Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
The updated Sequential Organ Failure Assessment (SOFA-2) score effectively predicts in-hospital mortality in emergency department patients with suspected infection. SOFA-2 shows similar performance to SOFA-1 but offers improved risk stratification for sepsis.
Area of Science:
- Critical Care Medicine
- Emergency Medicine
- Infectious Diseases
Background:
- The Sequential Organ Failure Assessment (SOFA) score is a standard tool for assessing organ dysfunction in suspected infections.
- However, SOFA-1 does not incorporate modern critical care practices.
- The newer SOFA-2 score aims to update these components, but its utility in emergency departments (EDs) is not well-established.
Purpose of the Study:
- To evaluate the performance of the SOFA-2 score in predicting in-hospital mortality among adult patients presenting to the ED with suspected infection.
- To compare the predictive accuracy of SOFA-2 against SOFA-1, quick SOFA (qSOFA), and Systemic Inflammatory Response Syndrome (SIRS) criteria.
Main Methods:
- A retrospective multi-institutional cohort study involving 173,079 adult patients across six Taiwanese hospitals (January 2010 - December 2021).
- Patients presenting to the ED with suspected infection were included.
- In-hospital mortality was the primary outcome, with predictive performance assessed using Area Under the Receiver Operating Characteristic curves (AUROC).
Main Results:
- SOFA-2 assigned lower scores than SOFA-1 for 62.3% of patients and higher scores for 1.5%.
- Patients with SOFA-2 scores reclassified to a higher category had significantly higher mortality (25.2%) compared to those with unchanged or lower scores.
- SOFA-2 demonstrated good discrimination for in-hospital mortality (AUROC 0.78), performing similarly to SOFA-1 (AUROC 0.78) and outperforming qSOFA (AUROC 0.72) and SIRS (AUROC 0.63).
Conclusions:
- SOFA-2 exhibits strong predictive validity for in-hospital mortality in ED patients with suspected infection.
- The findings support the use of SOFA-2 for early risk stratification in this population.
- SOFA-2 may inform future updates to sepsis definitions and clinical management guidelines.