Key result
The SOFA score on day one had significantly lower discriminative power for predicting hospital mortality (AUC 0.809) compared to the APACHE-IV (AUC 0.851) and SAPS-II (AUC 0.850) models in cardiac surgery patients.
Why the study?
APACHE-IV is the only validated ICU scoring system for cardiac surgery patients but is labor-intensive and error-prone, prompting evaluation of the simpler SOFA score as an alternative.
Does the SOFA score predict hospital and ICU mortality as accurately as traditional prognostic models in cardiac surgery patients?
Cohort (n=36,632)
Yes
Does the SOFA score predict hospital and ICU mortality as accurately as traditional prognostic models in cardiac surgery patients?
Effect estimate: AUC 0.809 (95% CI 0.808-0.810)
Absolute Event Rate: 0.809% vs 0.851%
The SOFA score underperforms compared to APACHE-IV and SAPS-II in predicting hospital and ICU mortality among cardiac surgery patients, suggesting it should not replace traditional prognostic models in this population.
SOFA underperforms traditional models for post-cardiac surgery ICU mortality prediction; leaves open whether simpler scores merit targeted validation or refinement.
Background There are many prognostic models and scoring systems in use to predict mortality in ICU patients. The only general ICU scoring system developed and validated for patients after cardiac surgery is the APACHE-IV model. This is, however, a labor-intensive scoring system requiring a lot of data and could therefore be prone to error. The SOFA score on the other hand is a simpler system, has been widely used in ICUs and could be a good alternative. The goal of the study was to compare the SOFA score with the APACHE-IV and other ICU prediction models. Methods We investigated, in a large cohort of cardiac surgery patients admitted to Dutch ICUs, how well the SOFA score from the first 24 h after admission, predict hospital and ICU mortality in comparison with other recalibrated general ICU scoring systems. Measures of discrimination, accuracy, and calibration (area under the receiver operating characteristic curve (AUC), Brier score, R2, and Ĉ-statistic) were calculated using bootstrapping. The cohort consisted of 36,632 Patients from the Dutch National Intensive Care Evaluation (NICE) registry having had a cardiac surgery procedure for which ICU admission was necessary between January 1st, 2006 and June 31st, 2018. Results Discrimination of the SOFA-, APACHE-IV-, APACHE-II-, SAPS-II-, MPM24-II - models to predict hospital mortality was good with an AUC of respectively: 0.809, 0.851, 0.830, 0.850, 0.801. Discrimination of the SOFA-, APACHE-IV-, APACHE-II-, SAPS-II-, MPM24-II - models to predict ICU mortality was slightly better with AUCs of respectively: 0.809, 0.906, 0.892, 0.919, 0.862. Calibration of the models was generally poor. Conclusion Although the SOFA score had a good discriminatory power for hospital- and ICU mortality the discriminatory power of the APACHE-IV and SAPS-II was better. The SOFA score should not be preferred as mortality prediction model above traditional prognostic ICU-models.
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Schoe et al. (2020) conducted a cohort in Cardiac surgery patients admitted to ICU (n=36,632). SOFA score vs. APACHE-IV, APACHE-II, SAPS-II, and MPM24-II models was evaluated on Hospital mortality discrimination (AUC) (AUC 0.809, 95% CI 0.808-0.810). The SOFA score on day one had significantly lower discriminative power for predicting hospital mortality (AUC 0.809) compared to the APACHE-IV (AUC 0.851) and SAPS-II (AUC 0.850) models in cardiac surgery patients.
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