SOFA Score prognostic performance among patients admitted to High-Dependency Units.

Abstract

The aim of this study was to assess prognostic stratification in patients admitted in two Italian Emergency-Department High-Dependency Units (ED-HDU). From June 2014, to July 2016, we recorded all patients admitted in the ED-HDU of the Careggi University Hospital and the Vittorio Emanuele University Hospital in a standardized database. Charlson Index and SOFA Score were calculated to evaluate comorbidity burden and severity of organ dysfunction. End-points were HDU and in-hospital mortality rate and need of Intensive Care Unit (ICU) transfer. The overall number of patients admitted in the two Units was 3311, 1822 in Florence and 1489 in Catania. HDU mortality rate was 5% (N.=171); compared with survivors, non-survivors showed a higher SOFA Score (10.0±4.2 vs. 3.5±2.9, P<0.001) and a higher number of organ dysfunctions (1.6±0.9 vs. 0.6±0.8, P<0.001). All patients with a SOFA Score in the first and second quartile survived HDU admission (only two non-survivors among patients in the second quartile), while mortality was disproportionally high in the group with a score value in the fourth quartile (0%, 0.2%, 3% and 14%, P<0.001). Presence and number of organ failure, as well as SOFA Score (5.6±4.0 vs. 3.4±2.8, P<0.001), were significantly higher in patients transferred to ICU than in those admitted in an ordinary ward or discharged. A higher SOFA Score (RR 1.55, 95% CI: 1.47-1.63, P<0.001) was associated with an increased HDU mortality, independent of age and Charlson Index. SOFA Score showed a good discrimination ability for both HDU - mortality and indication to increase the level of care.