Key result
A 24-hour increase in SOFA score >4 was associated with significantly higher in-hospital mortality compared to an increase of 2-4 (94.1% vs 58.8%, OR 11.2) in surgically critically ill patients.
Why the study?
Dynamic changes in the Sequential Organ Failure Assessment (SOFA) score may offer better prognostic value than a single measurement for early identification of critically ill surgical patients at high risk of mortality.
Does a change in SOFA score >4 within the first 24 hours predict higher in-hospital mortality compared to a change of 2-4 in critically ill surgical patients with shock and MODS?
Observational (n=200)
No
Does a change in SOFA score >4 within the first 24 hours predict higher in-hospital mortality compared to a change of 2-4 in critically ill surgical patients with shock and MODS?
Effect estimate: OR 11.2 (95% CI 2.5-50.8)
Absolute Event Rate: 94.1% vs 58.8%
p-value: p=0.002
An increase in SOFA score >4 within the first 24 hours is strongly associated with increased in-hospital mortality in critically ill surgical patients with shock and MODS.
ΔSOFA may aid early mortality risk stratification in surgical shock; hypothesis-generating and requires prospective validation before clinical adoption.
Introduction: Early identification of critically ill surgical patients at high risk of mortality is essential for timely intervention. The Sequential Organ Failure Assessment (SOFA) score is widely used to assess organ dysfunction, and dynamic changes in SOFA may provide better prognostic value than a single measurement. This study aimed to evaluate the role of change in SOFA score within the first 24 hours (ΔSOFA) as a predictor of mortality in surgically critically ill patients with shock and multiple organ dysfunction syndrome (MODS). Methods: This retrospective observational study was conducted in a tertiary care intensive care unit (ICU). Adult surgical patients (≥18 years) with shock and MODS were included. SOFA scores were calculated at admission and at 24 hours. ΔSOFA was determined as the difference between these values, and patients were categorized into ΔSOFA 2-4 and ΔSOFA >4 groups. The primary outcome was in-hospital mortality. Statistical analysis was performed using Fisher’s exact test, with p < 0.05 considered significant. Results: A total of 200 patients were included. The overall mortality rate was 40%. Among patients with ΔSOFA 2-4 (n = 68), mortality was 58.8%, whereas patients with ΔSOFA >4 (n = 34) had a significantly higher mortality of 94.1% (p = 0.002). Patients with ΔSOFA >4 had markedly higher odds of mortality compared to those with ΔSOFA 2-4 (odds ratio (OR) = 11.2, 95% confidence interval (CI): 2.5-50.8). Most patients had severe disease at admission, with high baseline SOFA scores and multi-organ involvement. Infectious etiology was the predominant cause of MODS. Conclusion: An increase in SOFA score within the first 24 hours is strongly associated with mortality in surgically critically ill patients. ΔSOFA is a simple, objective, and dynamic tool that can aid in early risk stratification and guide clinical decision-making in the ICU.
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Tiwari et al. (2026) conducted an observational in Critically ill surgical patients with shock and multiple organ dysfunction syndrome (MODS) (n=200). ΔSOFA >4 vs. ΔSOFA 2-4 was evaluated on In-hospital mortality (OR 11.2, 95% CI 2.5-50.8, p=0.002). A 24-hour increase in SOFA score >4 was associated with significantly higher in-hospital mortality compared to an increase of 2-4 (94.1% vs 58.8%, OR 11.2) in surgically critically ill patients.
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