Key result
Adding HbA1c to SOFA score outperforms SOFA alone in predicting diabetic sepsis mortality with AUC ~0.95.
Why the study?
Diabetes is a known predisposing factor for sepsis, and it was unclear whether adding HbA1c to SOFA score improves outcome prediction in diabetic sepsis patients.
Does the addition of HbA1c to the SOFA score improve the prediction of in-hospital mortality in diabetic patients with sepsis and septic shock?
Observational (n=98)
No
Does the addition of HbA1c to the SOFA score improve the prediction of in-hospital mortality in diabetic patients with sepsis and septic shock?
Adding HbA1c to the SOFA score (H-SOFA) improves the prediction of in-hospital mortality in diabetic patients with sepsis compared to the SOFA score alone.
May enhance sepsis mortality prediction in diabetics; hypothesis-generating and requires prospective validation before adoption.
Sepsis is a common cause of admissions into intensive care units (ICU’s). SOFA (sequential organ failure assessment) score has been validated as a prognostic marker in sepsis and there’s a good correlation between SOFA scoring and mortality of patients. Diabetes is a well-known predisposing factor for sepsis and we studied whether addition of HbA1c to SOFA score was helpful in predicting outcomes in diabetic patients with sepsis and septic shock. H-SOFA max score (HbA1c score added to maximum SOFA measured on any day of hospital stay) was the best predictor for in-hospital mortality. The mean H-SOFA (Max) score in the died (in-hospital mortality) group was 12.21 (±2.78), and in the discharged group was 5.49 (±2.68). Next best predictor was H-SOFA score (HbA1c score added to SOFA score at admission), followed by SOFA score. All the scores had a positive correlation with length of ICU stay. HbA1c (indicator of glycemic control) was helpful in predicting mortality when combined with the SOFA score (but not by itself). These scores may therefore be helpful to physicians and intensivists for prognostication of the patient and during counselling of the relatives, including end of life discussions.
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Panduranga et al. (2022) conducted an observational in Sepsis and septic shock in patients with type 2 diabetes (n=98). H-SOFA max score (HbA1c score + maximum SOFA score) vs. SOFA score alone was evaluated on In-hospital mortality prediction (AUC 0.953, p=<0.001). The H-SOFA max score, which adds HbA1c to the maximum SOFA score, accurately predicted in-hospital mortality in diabetic patients with sepsis (AUC 0.953) and outperformed the SOFA score alone.
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