Key result
The Δ-SOFA score was more powerful than the ED-SOFA score in predicting hospital mortality (AUC 0.81 vs 0.75), with survival rates of 51% for Δ-SOFA ≥2 vs 86.5% for Δ-SOFA 0-1 (P<0.001).
Why the study?
Do SOFA and Δ-SOFA scores predict hospital mortality in critically ill patients admitted to the ICU from the ED?
Cohort (n=269)
Do SOFA and Δ-SOFA scores predict hospital mortality in critically ill patients admitted to the ICU from the ED?
Effect estimate: AUC 0.81
Absolute Event Rate: 51% vs 86.5%
p-value: p=<0.001
Changes in the SOFA score over time (Δ-SOFA) are a powerful tool for risk stratification and predicting hospital mortality in critically ill patients admitted to the ICU from the ED.
OBJECTIVE: The condition of critically ill patients in the emergency department (ED) varies from moment to moment. The aims of this study are to quantify sequential organ failure assessment (SOFA) and changes in SOFA scores over time and determine its prognostic impact. PATIENTS AND METHODS: This is a prospective observational cohort study. We included 269 patients consecutively admitted to the ICU from the ED over 18 months. The SOFA scores at ED admission (ED-SOFA) and ICU admission (ICU-SOFA) were obtained. Relative changes in SOFA scores were calculated as follows: Δ-SOFA=ICU-SOFA-ED-SOFA. Patients were divided into two groups depending on the Δ-SOFA score: (a) Δ-SOFA=0-1; and (b) Δ-SOFA more than or equal to 2. RESULTS: The median ED-SOFA score was two points (interquartile range: 1-4.5) and the Δ-SOFA score was 2 points (interquartile range: 0-3). The Δ-SOFA score was more powerful (area under the curve: 0.81) than the ED-SOFA score (area under the curve: 0.75) in predicting hospital mortality. Sixteen (6%) patients had a Δ-SOFA score less than 0, 116 (43%) patients had a Δ-SOFA=0-1, and 137 (51%) patients had a Δ-SOFA of at least 2 points. The probability of being alive at hospital discharge was 51 and 86.5% in Δ-SOFA of at least 2 and Δ-SOFA=0-1 groups, respectively (P<0.001). Risk factors for an increase of two or more SOFA points were age, cirrhosis, a diagnosis of sepsis, and a prolonged ED stay. CONCLUSION: SOFA and changes in the SOFA score over time are potentially useful tools for risk stratification when applied to critically ill patients admitted to ICUs from the ED.
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García-Gigorro et al. (2017) conducted a cohort in Critically ill patients (n=269). Δ-SOFA score vs. ED-SOFA score was evaluated on Probability of being alive at hospital discharge (AUC 0.81, p=<0.001). The Δ-SOFA score was more powerful than the ED-SOFA score in predicting hospital mortality (AUC 0.81 vs 0.75), with survival rates of 51% for Δ-SOFA ≥2 vs 86.5% for Δ-SOFA 0-1 (P<0.001).
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