The validity of SOFA score to predict mortality in adult patients with cardiogenic shock on Veno-Arterial Extracorporeal Membrane Oxygenation

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background veno-arterial ECMO is increasingly used in resuscitation of adults patients with cardiogenic shock with variable mortality reports worldwide. Our objectives were to study the variables associated with hospital mortality and to determine the validity of the Sequential Organ Failure Assessment (SOFA) score for prediction of hospital mortality . Results : one hundred and six patients were retrospectively included in our study between 2015 and 2019 with in-hospital mortality of 56.6% . The mean age of patients was 40.2 ± 14.4 years and mostly males (69.8%) with a mean BMI of 26.5 ± 7 . Presence of CKD , chronic AF , cardiotomies were significantly more frequent in the non-survivors group . The non-survivors had more frequent AKI , more haemodialysis , more GI bleeding , more ICH, higher peak and 24 hours blood lactate and less ICU days as compared to the survivors group. Initial SOFA score ≥ 13 had a 85 % sensitivity and 73.9 % specificity [AUROC = 0.862 , 95% CI: 0.791 – 0.932 ; p <0.001 ] while SOFA score ≥ 13 at day 3 had 100 % sensitivity and 91.3 % specificity for predicting mortality [AUROC =0.995 , 95% CI : 0.986 – 1 ; p <0.001 ]. SOFA score ≥ 15 at day 5 had 98 % sensitivity and 100 % specificity for predicting mortality [AUROC =0.994 , 95% CI : 0.982 – 1 ; p <0.001 ]. The Δ 1 SOFA (3-1) ≥ 2 had 95% sensitivity and 93.5% specificity [AUROC = 0.958 , 95% CI: 0.913 – 1 ; p <0.001 ] while the Δ 2 SOFA (5-1) ≥ 2 had 90% sensitivity and 97.8% specificity for predicting hospital mortality [AUROC = 0.958 , 95% CI: 0.909 – 1 ; p <0.001 ] . Increasing Δ 1 SOFA score (OR = 2.506, 95% CI : 1.681 – 3.735,p < 0.001) and increasing lactate level (OR = 1.388 , 95% CI : 1.015 – 1.898 , p = 0.04) were significantly associated with hospital mortality . Conclusion: the use of VA-ECMO in adult patients with cardiogenic shock is still associated with high mortality . Serial evaluation with SOFA score during first few days of VA-ECMO support is a good predictor of hospital mortality . Increase of SOFA score after 48 hours and hyperlactataemia are significantly associated with increased hospital mortality. Predictors of hospital mortality.Studied variablesP valueOR95% CI for ORCentral VA-ECMO0.2483.1020.455 - 21.154lactate peak level0.0401.3881.015 - 1.898Haemodialysis0.7121.6140.127 - 20.473Δ 1 SOFA (3-1)< 0.0012.5061.681 - 3.735GI bleeding0.9170.8910.102 - 7.815ICH0.42414.5850.020 - 204.51Abstract Figure. SOFA scoring of studied VA-ECMO patients