Short-Term Delta-SOFA: is there a prognostic role in septic patients?

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BACKGROUND: SOFA Score is currently used to evaluate the severity of organ dysfunction during sepsis, but the prognostic value of the score’s variation during the first 24 hours has not been defined.METHODS: Prospective observational study. In the period from November 2011 to December 2016, we enrolled 268 patients, who were admitted to our High-Dependency Unit from the Emergency Department with a diagnosis of severe sepsis/septic shock. The SOFA score and the vital signs assessment were performed upon ED-HDU admission (T0), after 6 hours (T6) and 24 hours (T24) from admission. The primary end-points were day-7 and in-hospital mortality rates.RESULTS: Compared with survivors, non-survivors showed a higher SOFA (T0: 6.2±2.8 vs. 4.9±2.5; T6: 7.7±3.2 vs. 6.0±2.8; T24: 8.3±3.7 vs. 5.1±2.4, all P<0.01) and T24 ΔSOFA (2.4±3.3 vs. 0.3±1.9, P<0.001). We divided the study population in three subgroups based on the following criteria: 1) SOFA Score ≤5 and T6 ΔSOFA ≤1; 2) SOFA Score >5 or T6 ΔSOFA >1; 3) SOFA Score >5 and T6 ΔSOFA >1; the same analyses were repeated with T24 values. In-hospital mortality rate increased significantly in subgroups with a more severe organ damage at T6 (respectively 12%, 27% and 53%, P=0.001) and T24 evaluation (7%, 27% and 55%, P<0.001).CONCLUSIONS: The combination of a SOFA score≤5 with a Δ SOFA≤1 at T6 evaluation was associated with a very good prognosis in the short and the medium-term, while patients with one or both parameters in the highest range showed a high mortality rate.

The combination of a SOFA score ≤5 with a ΔSOFA ≤1 at 6 hours is associated with a very good short- and medium-term prognosis in septic patients.