Dr Lam Sau Yee
ICU, Kwong Wah Hospital
Abstract
Objective of the study
To validate the Sequential Organ Failure Assessment (SOFA) Score by using ICU mortality as the gold standard
Design: prospective, observational, validation cohort study conducted from 17th July, 2005 to 18th February, 2006 in the intensive care unit of Kwong Wah Hospital.
Setting: a thirteen-bed medical-surgical intensive care unit in a regional hospital of Hong Kong
Patients: 176 consecutive patients (mean age, 68 years) admitted to the intensive care unit for more than 24 hours for whom the SOFA score was calculated on admission and every 24hours thereafter until ICU discharge or death.
Main outcome measure: survival status at hospital discharge
Measurements and main results: In this cohort of patients, the median length of ICU stay was 4 days. The ICU mortality rate was 11% and hospital mortality was 18%. The initial, highest, mean, total and delta-SOFA score (Total maximum SOFA – D1 SOFA score) correlated well with mortality. Non-survivors had a higher total score on day 1 (6.89±3.87 vs 4.83±3.31, p=0.002) and thereafter until day 6. High SOFA scores in cardiovascular, coagulation, hepatic and neurological systems were associated with increased mortality. Total maximum score (TMS) was higher in non-survivors (10.91±4.579 vs 7.05±4.126, p<0.001) and delta-SOFA score was also independently related to outcome. The area under the receiver-operator-characteristic curve was 0.739 (p<0.001) for TMS score, 0.775 (p<0.001) for mean SOFA score. Increasing number of organ failures showed a trend to increase in mortality.
Conclusions: SOFA collected in a local intensive care unit demonstrated that it is a valid measure of multiple organ dysfunction/failure.