Serial SOFA-score trends in ICU-admitted COVID-19 patients as predictor of 28-day mortality: A prospective cohort study.

Abstract

The efficacy of Sequential Organ Failure Assessment (SOFA)score as predictor of clinical outcomes among ICU-admitted COVID-19 patients is still controversial. We aimed to assess whether SOFA-score in different time intervals could predict 28-day mortality compared with other well-acknowledged risk factors of COVID-19 mortality. This observational prospective cohort was conducted on 1057 patients from March 2020 to March 2022 at Masih Daneshvari Hospital, Iran. The univariate and multivariate Cox proportional analysis were performed to assess the hazards of SOFA-score models. Receiver operating characteristic (ROC)curves weredesigned to estimate the predictive values. Mean SOFA-score during first 96 h(HR: 3.82 [CI: 2.75-5.31]), highest SOFA-score (HR: 2.70 [CI: 1.93-3.78]), and initial SOFA-score (HR: 1.65 [CI: 1.30-2.11]) hadstrongest association with 28-daymortality (p < .0001). In contrast, SOFA scoresat 48and 96 has well as Δ-SOFA: 48-0 hand Δ-SOFA: 96-0 hdid not show significant correlations. Amongthem, merely mean SOFA-score (HR: 2.28 [CI: 2.21-3.51]; p < .001) remained as independent prognosticator on multivariate regression analysis; though having less odds of predicting value compared with age (HR: 3.81 [CI: 1.98-5.21]), hypertension (HR: 3.11 [CI: 1.26-3.81]), coronary artery disease [CAD] (HR: 2.82 [CI: 1.51-4.8]), and diabetes mellitus (HR: 2.45 [CI: 1.36-2.99]). The area under ROC (AUROC) for mean SOFA-score (0.77) and highest SOFA-score (0.71) were larger than other SOFA intervals. Calculating the first 96 hof SOFA trends, it was obtained that fatality rate was <12.3% if the score dropped, between 28.8%and 46.29% if the score remained unchanged, and >50.45% if the score increased. To predict the 28-day mortality among ICU-admitted COVID-19 patients, mean SOFA upon first 96 hof ICU stay is reliable; while having inadequate accuracy comparing with well-acknowledged COVID-19 mortality predictors (age, diabetes mellitus, hypertension, CAD). Notably, increased SOFA levels in the course of first 96 hof ICU-admission, prognosticate at least 50%fatality regardless of initial SOFA score.