VARIATION IN SOFA SCORE PERFORMANCE IN DIFFERENT INFECTIOUS STATES

Abstract

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: In this study, we investigated whether the sequential organ failure assessment (SOFA) score performance differs based on type of infection amongst patients admitted to the intensive care unit (ICU) with infection. METHODS: This is a single center, retrospective study at an urban tertiary care center in the United States. Adult patients admitted to the ICU with infection between January 2008 to December 2018 were included. Patients were uniquely classified into different infection types based on ICD-9 and ICD-10 codes. Infection types included were pneumonia, meningitis, bacteremia, cellulitis, cholangitis/cholecystitis, intestinal and diarrheal disease, endocarditis, urinary tract infection and peritonitis. SOFA score performance and mortality in relation to SOFA score (divided in quartiles of SOFA score of 0-3, 4-5, 6-8 and >8) was compared across infection types. RESULTS: A total of 12,283 patients were included. Of these, 50.6% were female and the median age was 70 (IQR 57-82) years. The most common infection types were pneumonia (32.2%) and UTI (31.0%). Overall, 1703 (13.9%) patients died prior to hospital discharge. The median baseline SOFA score (within 24 hours of ICU admission) for the cohort was 5 (3,8). Patients with peritonitis had the highest median SOFA score [7 (4,9)] and patients with cellulitis and UTI had the lowest median SOFA score [4 (2,7)]. SOFA score discrimination to predict mortality was highest among patients with endocarditis [area under the curve (AUC) 0.79, 95%CI: 0.69-0.90] and lowest for patients with isolated bacteremia (AUC 0.59, 95%CI: 0.49-0.70). Observed mortality by quartile of SOFA score differed substantially across infection types. Patients with pneumonia had a higher mortality in each SOFA quartile as compared to the remaining patients with other infection types (except peritonitis had highest mortality in 3rd and 4th quartile). Within each quartile of SOFA score, patients with cellulitis and pneumonia had substantially different mortality rates (quartile 1: 1.3% vs 10.4%, quartile 2: 4.4% vs 18.5%, quartile 3: 6.5% vs 26.3%, quartile 4: 17.4% vs 49.6%). Patients with cellulitis had lower mortality in each SOFA quartile (p≤0.01 for comparison in each quartile). CONCLUSIONS: Type of infection is an important consideration when interpreting the SOFA score. This is relevant as SOFA emerges as an important tool in the definition and prognostication of sepsis. CLINICAL IMPLICATIONS: Site of infection should be considered in addition to the SOFA score while prognosticating patients with sepsis and septic shock. DISCLOSURES: No relevant relationships by Lakshman Balaji, source=Web Response No relevant relationships by Michael Donnino, source=Web Response No relevant relationships by Anne Grossestreuer, source=Web Response No relevant relationships by Christopher Hansen, source=Web Response No relevant relationships by Ari Moskowitz, source=Web Response No relevant relationships by Parth Patel, source=Web Response No relevant relationships by Rahul Pawar, source=Web Response No relevant relationships by Jenny Shih, source=Web Response