Median Sequential Organ Failure Assessment Score Research Articles

Effect of the 1-h bundle on mortality in patients with suspected sepsis in the emergency department: a stepped wedge cluster randomized clinical trial.

The efficacy of the 1-h bundle for emergency department (ED) patients with suspected sepsis, which includes lactate measurement, blood culture, broad-spectrum antibiotics administration, administration of 30mL/kg crystalloid fluid for hypotension or lactate ≥ 4mmol/L, remains controversial. We carried out a pragmatic stepped-wedge cluster-randomized trial in 23 EDs in France and Spain. Adult patients with Sepsis-3 criteria or a quick sequential organ failure assessment (SOFA) score ≥ 2 or a lactate > 2mmol/L were eligible. The intervention was theimplementation of the 1-h sepsis bundle.The primary outcome was in-hospital mortality truncated at 28 days. Secondary outcomes included volume of fluid resuscitation at 24h, acute heart failure at 24h, SOFA score at 72h, intensive care unit (ICU) length of stay, number of days on mechanical ventilation or renal replacement therapy, vasopressor free days, unnecessary antibiotic administration, and mortality at 28days. 1148 patients were planned to be analysed; the study period ended after 873 patients were included. 872 patients (mean age 66, 42% female) were analyzed: 387 (44.4%) in the intervention group and 485 (55.6%) in the control group. Median SOFA score was 3 [1-5]. Median time to antibiotic administration was 40min in the intervention group vs 113min in the control group (difference - 73 [95% confidence interval (CI) - 93 to - 53]). There was a significantly higher rate, volume, and shorter time to fluid resuscitation within 3h in the intervention group. There were 47 (12.1%) in-hospital deaths in the intervention group compared to 61 (12.6%) in the control group (difference in percentage - 0.4 [95% CI - 5.1 to 4.2], adjusted relative risk (aRR) 0.81 [95% CI 0.48 to 1.39]). There were no differences between groups for other secondary endpoints. Among patients with suspected sepsis in the ED, the implementation of the 1-h sepsis bundle was not associated with significant difference in in-hospital mortality. However, this study may be underpowered to report a statistically significant difference between groups.

More attention should be paid to Omicron-associated sepsis: a multicenter retrospective study in south China.

The Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is highly transmissible but causes less severe disease compared to other variants. However, its association with sepsis incidence and outcomes is unclear. This study aimed to investigate the incidence of Omicron-associated sepsis, as per the Sepsis 3.0 definition, in hospitalized patients, and to explore its relationship with clinical characteristics and prognosis. This multicenter retrospective study included adults hospitalized with confirmed SARS-CoV-2 infection across six tertiary hospitals in Guangzhou, China from November 2022 to January 2023. The Sequential Organ Failure Assessment (SOFA) score and its components were calculated at hospital admission to identify sepsis. Outcomes assessed were need for intensive care unit (ICU) transfer and mortality. Receiver operating characteristic curves evaluated the predictive value of sepsis versus other biomarkers for outcomes. A total of 299 patients (mean age: 70.1±14.4 years, 42.14% female) with SOFA score were enrolled. Among them, 152 were categorized as non-serious cases while the others were assigned as the serious group. The proportion of male patients, unvaccinated patients, patients with comorbidity such as diabetes, chronic cardiovascular disease, and chronic lung disease was significantly higher in the serious than non-serious group. The median SOFA score of all enrolled patients was 1 (interquartile range, 0-18). In our study, 147 patients (64.19%) were identified as having sepsis upon hospital admission, with the majority of these septic patients (113, representing 76.87%) being in the serious group, the respiratory, coagulation, cardiovascular, central nervous, and renal organ SOFA scores were all significantly higher in the serious compared to the non-serious group. Among septic patients, 20 out of 49 (40.81%) had septic shock as indicated by lactate measurement within 24 hours of admission, and the majority of septic patients were in the serious group (17/20, 76.87%). Sepsis was present in 118 out of 269 (43.9%) patients in the general ward, and among those with sepsis, 34 out of 118 (28.8%) later required ICU care during hospitalization. By contrast, none of the patients without sepsis required ICU care. Moreover, the mortality rate was significantly higher in patients with than without sepsis. A considerable proportion of patients infected with Omicron present with sepsis upon hospital admission, which is associated with a poorer prognosis. Therefore, early recognition of viral sepsis by evaluation of the SOFA score in hospitalized coronavirus disease 2019 patients is crucial.

Validity of the total SOFA score in patients ≥ 80 years old acutely admitted to intensive care units: a post-hoc analysis of the VIP2 prospective, international cohort study

BackgroundLittle is known about the performance of the Sequential Organ Failure Assessment (SOFA) score in older critically ill adults. We aimed to evaluate the prognostic impact of physiological disturbances in the six organ systems included in the SOFA score.MethodsWe analysed previously collected data from a prospective cohort study conducted between 2018 and 2019 in 22 countries. Consecutive patients ≥ 80 years old acutely admitted to intensive care units (ICUs) were eligible for inclusion. Patients were followed up for 30 days after admission to the ICU. We used logistic regression to study the association between increasing severity of organ dysfunction and mortality.ResultsThe median SOFA score among 3882 analysed patients was equal to 6 (IQR: 4–9). Mortality was equal to 26.1% (95% CI 24.7–27.5%) in the ICU and 38.7% (95% CI 37.1–40.2%) at day 30. Organ failure defined as a SOFA score ≥ 3 was associated with variable adjusted odds ratios (aORs) for ICU mortality dependant on the organ system affected: respiratory, 1.53 (95% CI 1.29–1.81); cardiovascular 1.69 (95% CI 1.43–2.01); hepatic, 1.74 (95% CI 0.97–3.15); renal, 1.87 (95% CI 1.48–2.35); central nervous system, 2.79 (95% CI 2.34–3.33); coagulation, 2.72 (95% CI 1.66–4.48). Modelling consecutive levels of organ dysfunction resulted in aORs equal to 0.57 (95% CI 0.33–1.00) when patients scored 2 points in the cardiovascular system and 1.01 (0.79–1.30) when the cardiovascular SOFA equalled 3.ConclusionsDifferent components of the SOFA score have different prognostic implications for older critically ill adults. The cardiovascular component of the SOFA score requires revision.

Differences in Mortality Among Patients With Asthma and COPD Hospitalized With COVID-19

It remains unclear whether patients with asthma and/or chronic obstructive pulmonary disease (COPD) are at increased risk for severe coronavirus disease 2019 (COVID-19). Compare in-hospital COVID-19 outcomes among patients with asthma, COPD, and no airway disease. A retrospective cohort study was conducted on 8,395 patients admitted with COVID-19 between March 2020 and April 2021. Airway disease diagnoses were defined using International Classification of Diseases, 10th Revision codes. Mortality and sequential organ failure assessment (SOFA) scores were compared among groups. Logistic regression analysis was used to identify and adjust for confounding clinical features associated with mortality. The median SOFA score in patients without airway disease was 0.32 and mortality was 11%. In comparison, asthma patients had lower SOFA scores (median 0.15; P < .01) and decreased mortality, even after adjusting for age, diabetes, and other confounders (odds ratio 0.65; P= .01). Patients with COPD had higher SOFA scores (median 0.86; P < .01) and increased adjusted odds of mortality (odds ratio 1.40; P < .01). Blood eosinophil count of 200 cells/μL or greater, a marker of type 2 inflammation, was associated with lower mortality across all groups. Importantly, patients with asthma showed improved outcomes even after adjusting for eosinophilia, indicating that noneosinophilic asthma was associated with protection as well. COVID-19 severity was increased in patients with COPD and decreased in those with asthma, eosinophilia, and noneosinophilic asthma, independent of clinical confounders. These findings suggest that COVID-19 severity may be influenced by intrinsic immunological factors in patients with airway diseases, such as type 2 inflammation.

The Effect of Ketamine Versus Etomidate for Rapid Sequence Intubation on Maximum Sequential Organ Failure Assessment Score: A Randomized Clinical Trial

BackgroundThe use of induction agents for rapid sequence intubation (RSI) has been associated with hypotension in critically ill patients. Choice of induction agent may be important and the most commonly used agents are etomidate and ketamine. ObjectiveThis study aimed to compare the effects of a single dose of ketamine vs. etomidate for RSI on maximum Sequential Organ Failure Assessment (SOFA) score and incidence of hypotension. MethodsThis single-center, randomized, parallel-group trial compared the use of ketamine and etomidate for RSI in critically ill adult patients in the emergency department. The study was performed under Exception from Informed Consent. The primary outcome was the maximum SOFA score within 3 days of hospitalization. ResultsA total of 143 patients were enrolled in the trial, 70 in the ketamine group and 73 in the etomidate group. Maximum median SOFA score for the ketamine group was 6.5 (interquartile range [IQR] 5–9) vs. 7 (IQR 5–9) for etomidate with no significant difference (–0.2; 95% CI –1.4 to 1.1; p = 0.79). The incidence of post-intubation hypotension was 28% in the ketamine group vs. 26% in the etomidate group (difference 2%; 95% CI –13% to 17%). There were no significant differences in intensive care unit outcomes. Thirty-day mortality rate for the ketamine group was 11% (8 deaths) and for the etomidate group was 21% (15 deaths), which was not statistically different. ConclusionsThere were no significant differences in maximum SOFA score or post-intubation hypotension between critically ill adults receiving ketamine vs. etomidate for RSI.

Prognostic Role of Serum Albumin in Predicting 30-Day Mortality in Patients with Infections in Emergency Department: A Prospective Study.

Infections in emergency departments (EDs) are insidious clinical conditions characterised by high rates of hospitalisation and mortality in the short-to-medium term. The serum albumin, recently demonstrated as a prognostic biomarker in septic patients in intensive care units, could be an early marker of severity upon arrival of infected patients in the ED. To confirm the possible prognostic role of the albumin concentration recorded upon arrival of patients with infection. A prospective single-centre study was performed in the ED of the General Hospital of Merano, Italy, between 1 January 2021 and 31 December 2021. All enrolled patients with infection were tested for serum albumin concentration. The primary outcome measure was 30-day mortality. The predictive role of albumin was assessed by logistic regression and decision tree analysis adjusted for Charlson comorbidity index, national early warning score, and sequential organ failure assessment (SOFA) score. 962 patients with confirmed infection were enrolled. The median SOFA score was 1 (0-3) and the mean serum albumin level was 3.7 g/dL (SD 0.6). Moreover, 8.9% (86/962) of patients died within 30 days. Albumin was an independent risk factor for 30-day mortality with an adjusted hazard ratio of 3.767 (95% CI 2.192-6.437), p < 0.001. Decision tree analysis indicated that at low SOFA scores, albumin had a good predictive ability, indicating a progressive mortality risk reduction in concentrations above 2.75 g/dL (5.2%) and 3.52 g/dL (2%). Serum albumin levels at ED admission are predictive of 30-day mortality in infected patients, showing better predictive abilities in patients with low-to-medium SOFA scores.

Medication regimen complexity (MRC-ICU) for in-hospital mortality prediction in COVID-19 patients.

The medication regimen complexity-intensive care unit (MRC-ICU) score was developed prior to the existence of COVID-19. The purpose of this study was to assess if MRC-ICU could predict in-hospital mortality in patients with COVID-19. A single-center, observational study was conducted from August 2020 to January 2021. The primary outcome of this study was the area under the receiver operating characteristic (AUROC) for in-hospital mortality for the 48-hour MRC-ICU. Age, sequential organ failure assessment (SOFA), and World Health Organization (WHO) COVID-19 Severity Classification were assessed. Logistic regression was performed to predict in-hospital mortality as well as WHO Severity Classification at 7 days. A total of 149 patients were included. The median SOFA score was 8 (IQR 5-11) and median MRC-ICU score at 48 hours was 15 (IQR 7-21). The in-hospital mortality rate was 36% (n = 54). The AUROC for MRC-ICU was 0.71 (95% Confidence Interval (CI), 0.62-0.78) compared to 0.66 for age, 0.81 SOFA, and 0.72 for the WHO Severity Classification. In univariate analysis, age, SOFA, MRC-ICU, and WHO Severity Classification all demonstrated significant association with in-hospital mortality, while SOFA, MRC-ICU, and WHO Severity Classification demonstrated significant association with WHO Severity Classification at 7 days. In univariate analysis, all 4 characteristics showed significant association with mortality; however, only age and SOFA remained significant following multivariate analysis. In the first analysis of medication-related variables as a predictor of severity and in-hospital mortality in COVID-19, MRC-ICU demonstrated acceptable predictive ability as represented by AUROC; however, SOFA was the strongest predictor in both AUROC and regression analysis.

Evaluation of an electronic health record documentation tool use to improve pharmacist intervention tracking in the intensive care unit

AbstractPurposePharmacists are integral members of the healthcare team, but interventions are not always captured due to documentation limitations. This study evaluated the impact of implementing a tracking tool to address gaps in capturing pharmacist interventions.MethodsA prospective, observational study was conducted to assess pharmacist interventions between July and November 2020. Twelve critical care pharmacists captured interventions on 10 weekdays using a tracking tool (iVent—Epic®) embedded in the electronic medical record (EMR) to capture high frequency interventions not standardly captured via existing standard note documentation (e.g., renal/hepatic dose adjustment, parenteral nutrition management). Value added of the interventions is proposed. Patients' baseline demographics, interventions, Sequential Organ Failure Assessment (SOFA) score, and intensive care unit (ICU) length of stay (LOS) were collected. The primary outcome was to determine the added benefit of using a tracking tool within the EMR to capture pharmacist interventions compared to progress note documentation.ResultsTwo thousand seven hundred and eighty‐three interventions were documented on 514 unique patients over 120 pharmacist shifts. Of these, 2363 (84.9%) interventions were captured through iVent tracking. The median SOFA score on day of intervention was 4 [interquartile range (IQR) 2–7] and ICU LOS was 3.5 days [IQR 1.5–9]. The median number of interventions per patient per day was 2 [IQR 1–3]. A significant difference was observed among days of the week and the number of iVents documented (χ2 = 13.172, p = 0.01, df = 4). The post hoc pairwise comparison revealed more documented iVents on Tuesday than Friday.ConclusionThis study reveals that an iVent tracking tool increased total capture of pharmacist interventions by 563%. These interventions can be associated with value‐based programs and further work is needed in highlighting the pharmacist's role in these new payment models. This study confirms that the current standard practice at this institution of solely entering pharmacist progress notes into the patient chart misses a majority of pharmacist interventions.

1005: MORTALITY PREDICTION USING MEDICATION-RELATED DATA IN PATIENTS WITH COVID-19

Introduction: The medication regimen complexity-intensive care unit (MRC-ICU) score was developed prior to the existence of COVID-19 and has demonstrated an association with increased mortality, ICU length of stay, fluid balance, drug interactions, and quantity and quality of pharmacist interventions. Previous reports have questioned the ability of traditional predictors of mortality in critically ill patients to predict death in patients with COVID-19. The purpose of this study was to assess if MRC-ICU could predict mortality patients with COVID-19. Methods: A single-center, observational study was conducted from August 2020 to January 2021. The primary outcome of this study was the area under the receiver operating characteristic (AUROC) for mortality for the 48-hour MRC-ICU. Age, sequential organ failure assessment (SOFA), and World Health Organization (WHO) COVID-19 Severity Classification were also assessed. Logistic regression was also performed to predict mortality as well as WHO Severity Classification at 7 days. Results: A total of 149 patients were included. The median SOFA score was 8 (IQR 5 – 11) and median MRC-ICU score at 48 hours was 15 (IQR 7 – 21). The in-hospital mortality rate was 36% (n = 54). The AUROC for MRC-ICU was 0.71 (95% Confidence Interval (CI), 0.62 – 0.78) compared to 0.66 for age, 0.81 SOFA, and 0.72 for the WHO Severity Classification. In univariate analysis, age, SOFA, MRC-ICU, and WHO Severity Classification all demonstrated significant association with mortality, while SOFA, MRC-ICU, and WHO Severity Classification demonstrated significant association with WHO Severity Classification at 7 days. A multiple logistic regression model for mortality was developed using these four predictors. Conclusions: In the first analysis of medication-related variables as a predictor of severity and mortality in COVID-19, MRC-ICU demonstrated acceptable predictive ability; however, SOFA was the strongest predictor in both AUROC and regression analysis.

A COMPARISON OF SEQUENTIAL ORGAN FAILURE (SOFA) &amp; QUICK SOFA SCORES IN PREDICTING HOSPITAL MORTALITY IN CRITICALLY ILL PATIENTS IN A TERTIARY CARE CENTRE

Background: To validate Q-SOFA for predicting In-hospital mortality in patients presenting with sepsis in an ICU setting and comparing it to SOFA (Sequential organ failure assessment) score. To compare the performance of the SOFA score and qSOFA scores for in-hospital mortality prediction among critically ill patients in an ICU setting in a tertiary care center. Aims And Objectives: To compare the performance of the SOFA score and qSOFA scores for in-hospital mortality prediction among critically ill patients in an ICU setting in a tertiary care center This study was done in the D Methodolgy: epartment of Medicine in Kurnool Medical College, Kurnool among patients with age &gt; 18 years with suspected infection who were treated at the ICU of Government General Hospital. In our study Results: 2 scoring systems were used –QSOFA and SOFA –both of which are acceptable scoring systems in sepsis. Each of these scores was analyzed with mortality to determine which test predicted mortality better at discharge and at 28 days post-discharge follow-up. On comparing the SOFA score with mortality it was found that 81.82% of the patients who expired at discharge and 77.78 % of the patients who expired at 28 days postdischarge had a SOFA score more than 11(the median SOFA score). At discharge, the sensitivity along with the specicity of SOFA score was 81.8% and 97.4% respectively and at 28 days follow-up, the sensitivity, and specicity in predicting mortality were 77.78% and 100% respectively. On comparing Q-SOFA score with mortality it was found that 63.64% of the patients who expired at discharge and 77.78% of the patients who expired at 28 days post-discharge had a Q-SOFA score of more than 2. At discharge, the calculated sensitivity, as well as specicity of the Q-SOFA score, was 63.6% and 56.4% respectively and at 28 days post-discharge it was 77.78% and 66.7% respectively. AUROC was also calculated for the above-mentioned scoring systems in denoting its predictive power for mortality in sepsis patients. At both discharge and 28 days post-discharge follow-up, SOFA score was found better in predicting mortality followed by Q-SOFA score. Given that both SOFA and QSOFA have sensitivities close to each other for both In-hospital and 28-day mortality (81.8% vs. 63.6%) and (77.78% vs. 77.78%), the Q-SOFA could be used for rapid assessment before lab investigations are available for early goal-directed therapy, though SOFA is the most accurate score for predicting mortality 1. Sepsis scoring system Q-SOFA showed a sensitivi Conclusion: ty of 63.6 % at discharge and 70% at 28 days follow-up for predicting mortality in patients presenting with sepsis 2. Comparison of SOFA, Q-SOFA it was revealed that SOFA score predicted the mortality of sepsis the best both at discharge and at 28 days follow-up.

Usefulness of sequential organ failure assessment score on admission to predict the 90-day mortality in patients with exertional heatstroke: An over 10-year intensive care survey

Background and objectivesDespite a growing understanding of exertional heatstroke (EHS), there is a paucity of clinical evidence for risk-stratification of patients with EHS. The objective of this study was to identify an appropriate scoring system for prognostic assessment of EHS. MethodsThis was a retrospective cohort study of all patients with EHS admitted to intensive care unit (ICU) of the General Hospital of Southern Theatre Command of PLA between October 2008 and May 2019. Inflammatory indices and organ function parameters at admission, the Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, Sequential Organ Failure Assessment (SOFA) scores, and Glasgow Coma Scale (GCS) score were collected. Risk factors for 90-day mortality were identified using multivariate Cox proportional hazard risk regression model. Results189 patients (all male) were finally included, with a median age of 21.0 years (IQR 19.0–27.0), median APACHE II score of 11.0 (IQR 8.0–16.0), median SOFA score of 3.0 (IQR 2.0–6.0), and median GCS score of 12.0 (IQR 7.0–14.0). There were 166 survivors (87.8%) and 23 non-survivors (12.2%). Compared with survivor group, non-survivors had higher incidence of severe organ damage, including rhabdomyolysis (46.1% vs 63.6%), disseminated intravascular coagulation (25.6% vs 90.0%), acute liver injury (69.4% vs 95.7%), and acute kidney injury (36.6% vs 95.7%). Multivariate Cox risk regression model showed that SOFA score was an independent risk factor for 90-day mortality, with an optimal cutoff score of 7.5. ConclusionsSOFA score may be a clinically useful predictor of death in EHS. Prospective studies are required to confirm the effectiveness of SOFA score and the optimal cutoff level.

Evaluation of the possibility of using urinary neutrophil gelatinase-dependent lipocalin as a predictor of acute kidney injury in intensive care unit patients

Introduction: Due to the increase in the incidence of acute kidney injury (AKI), especially in patients admitted to the intensive care unit (ICU), its occurrence has been studied using biomarkers such as urinary neutrophil gelatinase-dependent lipocalin (uNGAL). However, its clinical utility has not yet been approved. Objectives: This study aimed to investigate the possibility of using uNGAL as a predictor of AKI in patients admitted to the ICU. Patients and Methods: This prospective study was conducted on 32 patients admitted to the ICU who had normal creatinine level at the ICU admission and did not fulfill the RIFLE (risk, injury, failure, loss of kidney function, and end-stage kidney disease) criteria. Initially, creatinine level and the sequential organ failure assessment (SOFA) score were recorded. In the first 24 hours of hospitalization, urine samples were taken from patients to assess uNGAL levels. In the following days, creatinine levels and the day of its rise were recorded. The incidence of AKI was assessed based on the RIFLE criteria, and the relationship between the AKI incidence and the uNGAL level at admission was assessed. Results: The mean (SD) of patients’ age was 63 ± 17 years, and 18 patients (56%) were male. The cause of hospitalization was post-cardiac surgery in 21 patients (66%). The median SOFA score of patients was 2.5 at admission. According to the RIFLE criteria, 47% of patients had kidney problems at different stages. The median length of hospital stay was 13 days, while four patients (13%) died. Range and mean (SD) of uNGAL level at admission in all patients was 46.1 to 172.5 ng/mL and 89.94 ± 30.9 ng/mL, respectively, which was not significantly different between the two sexes and between living and deceased patients. Although the mean of uNGAL increased in patients in the risk and injury stage of the RIFLE criteria compared to normal patients, the difference between them was not significant. The increase in uNGAL was directly related to the increase in SOFA score (Spearman’s rho = 0.360, P = 0.043), while its changes was not significantly related to age or creatinine elevation ratio. Conclusion: The findings of our study showed that, in ICU admitted patients, first-day uNGAL level was not helpful in predicting AKI based on the RIFLE criteria.

Predictive ability of the sequential organ failure assessment score for in-hospital mortality in patients with cardiac critical illnesses: a nationwide observational study.

Several studies have reported a high predictive ability of the Sequential Organ Failure Assessment (SOFA) score for in-hospital mortality specifically for patients with cardiac critical illnesses, however, differences according to the admission classification (surgical or non-surgical) are unknown. The present study aimed to evaluate the predictive ability of the SOFA score in surgical and non-surgical patients with cardiac critical illnesses. Using the Japanese nationwide Diagnosis Procedure Combination database, we identified patients with cardiac critical illnesses, defined as patients admitted to the intensive care unit (ICU) and treated by cardiologists or cardiovascular surgeons as their physicians in charge from April 2018 to March 2020. The discriminatory ability of the SOFA score for in-hospital mortality was assessed by calculating the area under the receiver operating characteristic curve (AUROC). Among 52 819 eligible patients with available data on their SOFA scores, 33 526 (64%) were postoperative cardiac surgeries. The median SOFA score on ICU admission was 5.0 (interquartile range, 2.0-8.0) and overall in-hospital mortality 6.8%. The AUROC of the SOFA score was 0.75 [95% confidence interval (CI), 0.75-0.76]. In the subgroup analyses, the AUROCs were 0.76 (95% CI, 0.74-0.77) in the surgical patients, 0.83 (95% CI, 0.83-0.84) in the non-surgical patients, and 0.88 (95% CI, 0.87-0.89) in the non-surgical acute coronary syndrome patients. The predictive ability of the SOFA score on the day of ICU admission for in-hospital mortality was confirmed to be acceptable in the patients with cardiac critical illnesses and varied according to the admission classification and primary diagnoses.

Monitoring the Sequential Organ Failure Assessment score in nonocclusive mesenteric ischemia increases the survival rate

Several large-scale studies have assessed the endovascular and surgical treatments for nonocclusive mesenteric ischemia (NOMI); nonetheless, the prognostic factors for NOMI remain unclear.In this single-center study, we retrospectively reviewed the electronic medical records of 197, 149 patients were retrieved from the inpatient database of our hospital from January 2011 to January 2020; 79 patients with NOMI were observed. A total of 44 patients who underwent laparotomy were statistically analyzed and divided into the survivor and non-survivor groups. Prognostic factors were compared between the 2 groups. Exploratory laparotomy based on a second-look surgery was the first treatment choice.The overall mortality rate was 61.3%, with a male-to-female ratio of 1.6:1. The median Sequential Organ Failure Assessment (SOFA) score was 11.06 [5.75-17.25]. The median SOFA score was 5 [interquartile range: 3-8] in the survivor group and 14.8 [interquartile range: 10.5-19] in the non-survivor group. The log-rank test showed a significant difference in the presence of diabetes mellitus (P = .025), hypoglycemia (P = .001), SOFA score ≥10 (P < .001), hemoglobin levels ≥11 g/dL (P = .003), platelet count ≥12.9 × 104/μL (P = .01), lactate levels ≥2.6 mmol/L (P = .005), and base excess <-3.0 (P < .023). Multivariate analysis using the factors with significant differences revealed that SOFA score ≥10 (hazard ratio for death, 1.199; 95% confidence interval, 1.101-1.305; P < .001) was an independent prognostic factor.The SOFA score can be used to assess disease severity. A SOFA score of ≥10 may be associated with increased mortality.

Discriminatory accuracy of the SOFA score for determining clinical decompensation in patients presenting with COVID-19

IntroductionWhile the global dissemination of vaccines targeting the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a decline in the incidence of infections, the case fatality rates have remained relative stable. A major objective of managing hospitalized patients with documented or suspected COVID-19 infection is the rapid identification of features associated with severe illness using readily available laboratory tests and clinical tools. The sequential organ failure assessment (SOFA) score is a validated tool to facilitate the identification of patients at risk of dying from sepsis.PurposeThe aim of this study was to assess the discriminatory accuracy of the SOFA score in predicting clinical decompensation in patients hospitalized with COVID-19 infection.MethodsWe conducted a retrospective analysis at a three-hospital health system, comprised of one tertiary and two community hospitals, located in the Chicago metropolitan area. All patients had positive SARS-CoV-2 testing and were hospitalized for COVID-19 infection. The primary outcome was clinical decompensation, defined as the composite endpoint of death, ICU admission, or need for intubation. We utilized the most abnormal laboratory values observed during the admission to calculate the SOFA score. Receiver Operating Curves (ROC) were then constructed to determine the sensitivity and specificity of SOFA scores.ResultsBetween March 1st and May 31st 2020, 1029 patients were included in our analysis with 367 patients meeting the study endpoint. The median SOFA score was 2.0 IQR (Q1, Q3 1,4) for the entire cohort. Patients who had in-hospital mortality had a median SOFA score of 4.0 (Q1,Q3 3,7). In patients that met the primary composite endpoint, the median SOFA score was 3.0, IQR (Q1, Q3 2,6). The ROC was 0.776 (95% CI 0.746–0.806, p<0.01).ConclusionThe SOFA score demonstrates strong discriminatory accuracy for prediction of clinical decompensation in patients presenting with COVID-19 at our urban hospital system.Funding AcknowledgementType of funding sources: Public hospital(s). Main funding source(s): Loyola University Medical Center

The prognostic value of the SOFA score in patients with COVID-19: A retrospective, observational study.

Coronavirus disease 2019 (COVID-19) can lead to serious illness and death, and thus, it is particularly important to predict the severity and prognosis of COVID-19. The Sequential Organ Failure Assessment (SOFA) score has been used to predict the clinical outcomes of patients with multiple organ failure requiring intensive care. Therefore, we retrospectively analyzed the clinical characteristics, risk factors, and relationship between the SOFA score and the prognosis of COVID-19 patients.We retrospectively included all patients ≥18 years old who were diagnosed with COVID-19 in the laboratory continuously admitted to Jingzhou Central Hospital from January 16, 2020 to March 23, 2020. The demographic, clinical manifestations, complications, laboratory results, and clinical outcomes of patients infected with the severe acute respiratory syndrome coronavirus-2 were collected and analyzed. Clinical variables were compared between patients with mild and severe COVID-19. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for severe COVID-19. The Cox proportional hazards model was used to analyze risk factors for hospital-related death. Survival analysis was performed by the Kaplan–Meier method, and survival differences were assessed by the log-rank test. Receiver operating characteristic (ROC) curves of the SOFA score in different situations were drawn, and the area under the ROC curve was calculated.A total of 117 patients with confirmed diagnoses of COVID-19 were retrospectively analyzed, of which 108 patients were discharged and 9 patients died. The median age of the patients was 50.0 years old (interquartile range [IQR], 35.5–62.0). 63 patients had comorbidities, of which hypertension (27.4%) was the most frequent comorbidities, followed by diabetes (8.5%), stroke (4.3%), coronary heart disease (3.4%), and chronic liver disease (3.4%). The most common symptoms upon admission were fever (82.9%) and dry cough (70.1%). Regression analysis showed that high SOFA scores, advanced age, and hypertension were associated with severe COVID-19. The median SOFA score of all patients was 2 (IQR, 1–3). Patients with severe COVID-19 exhibited a significantly higher SOFA score than patients with mild COVID-19 (3 [IQR, 2–4] vs 1 [IQR, 0–1]; P < .001). The SOFA score can better identify severe COVID-19, with an odds ratio of 5.851 (95% CI: 3.044–11.245; P < .001). The area under the ROC curve (AUC) was used to evaluate the diagnostic accuracy of the SOFA score in predicting severe COVID-19 (cutoff value = 2; AUC = 0.908 [95% CI: 0.857–0.960]; sensitivity: 85.20%; specificity: 80.40%) and the risk of death in COVID-19 patients (cutoff value = 5; AUC = 0.995 [95% CI: 0.985–1.000]; sensitivity: 100.00%; specificity: 95.40%). Regarding the 60-day mortality rates of patients in the 2 groups classified by the optimal cutoff value of the SOFA score (5), patients in the high SOFA score group (SOFA score ≥5) had a significantly greater risk of death than those in the low SOFA score group (SOFA score < 5).The SOFA score could be used to evaluate the severity and 60-day mortality of COVID-19. The SOFA score may be an independent risk factor for in-hospital death.

Accuracy of the Sequential Organ Failure Assessment Score for In-Hospital Mortality by Race and Relevance to Crisis Standards of Care

Crisis Standards of Care (CSC) are guidelines for rationing health care resources during public health emergencies. The CSC adopted by US states ration intensive care unit (ICU) admission using the Sequential Organ Failure Assessment (SOFA) score, which is used to compare expected in-hospital mortality among eligible patients. However, it is unknown if Black and White patients with equivalent SOFA scores have equivalent in-hospital mortality. To investigate whether reliance on SOFA is associated with bias against Black patients in CSC. This cohort study was conducted using data from the eICU Collaborative Research Database of patients admitted to 233 US ICUs in 2014 to 2015. Included individuals were Black and White adult patients in the ICU, who were followed up to hospital discharge. Data were analyzed from May 2020 through April 2021. SOFA scores at ICU admission. Hierarchical logistic regression with hospital fixed effects was used to measure the interaction between race and SOFA as a factor associated with in-hospital mortality, as well as the odds of death among Black and White patients with equivalent priority for resource allocation according to the SOFA-based ranking rules of 3 statewide CSC (denoted A, B, and C) under shortage conditions that were severe (ie, only patients with the highest priority would be eligible for allocation), intermediate (ie, patients in the highest 2 tiers would be eligible for allocation), or low (ie, only patients with the lowest priority would be at risk of exclusion). Among 111 885 ICU encounters representing 95 549 patients, there were 16 688 encounters with Black patients (14.9%) and 51 464 (46.0%) encounters with women and the mean (SD) age was 63.3 (16.9) years. The median (interquartile range) SOFA score was not statistically significantly different between Black and White patients (4 [2-6] for both groups; P = .19), but mortality was lower among Black individuals compared with White individuals with equivalent SOFA scores (odds ratio [OR], 0.98; 95% CI, 0.97-0.99; P < .001). This was associated with lower mortality among Black patients compared with White patients prioritized for resource allocation in 3 CSC under shortage conditions that were severe (system A: OR, 0.65; 95% CI, 0.58-0.74; P < .001; system B: OR, 0.70; 95% CI, 0.64-0.78; P < .001; system C: OR, 0.73; 95% CI, 0.67-0.80; P < .001), intermediate (system A: OR, 0.73; 95% CI, 0.67-0.80; P < .001; system B: OR, 0.83; 95% CI, 0.77-0.89; P < .001; system C: OR, 0.82; 95% CI, 0.77-0.89; P < .001), and low (system A: OR, 0.83; 95% CI, 0.77-0.89; P < .001; system C: OR, 0.86; 95% CI, 0.81-0.92; P < .001; not applicable for system B, which had fewer tiers). When SOFA-based ranking rules were adjusted for Black patients to simulate equitable allocation based on observed mortality, the proportion upgraded to higher priority ranged from 379 Black patient encounters (2.3%) in low shortage conditions to 2601 Black patient encounters (15.6%) in severe shortage conditions. This study found that SOFA scores were associated with overestimated mortality among Black patients compared with White patients, and this was associated with a structural disadvantage for Black patients in CSC allocation systems. These findings suggest that guidelines should be revised to correct this inequity and alternative methods should be developed for more equitable triage.

Accuracy of SOFA Score to Predict Outcome in Community-Acquired Sepsis

Background: The new definition of Sepsis-3 defines sepsis as life-threatening organ dysfunction, demonstrated by an increase in the Sequential Organ Failure Assessment (SOFA) of 2 or more points, caused by a dysregulated host response to infection. The performance of SOFA score data in a setting of a tertiary public hospital in a middle-income country remains limited. Objective: To determine the accuracy of the SOFA score to predict the 28-day mortality in community-acquired sepsis patients. Materials and Methods: A retrospective study enrolled community-acquired sepsis and septic shock patients admitted between January and December 2015 in Hatyai Hospital, a tertiary public Hospital in Southern Thailand. All variables for calculating the SOFA and qSOFA scores were collected. The primary outcome was the 28-day mortality. Results: Three hundred seventy-nine patients were enrolled. Eighty-seven patients (23%) died. The median (IQR) SOFA score was 6 (3, 9) points. The SOFA score had a fair predictive performance (AUROC 0.71, 95% CI 0.65 to 0.77), which was higher than qSOFA score (AUROC 0.67, 95% CI 0.62 to 0.73). The SOFA score of 2 points associated with mortality (13%) and higher score patients had an incremental increase mortality rate. The hazard ratio (HR) was 4.59 (95% Cl 1.3 to 15.78, p=0.02) for SOFA Score 6 to 7 points. Conclusion: Among patients presenting with community-acquired infection, the SOFA score indicated the fair predicting ability for the 28-day mortality and performed better than qSOFA score. Keywords: SOFA, qSOFA, Sepsis, Accuracy, Mortality, Community-acquired infection, Thailand

Circulatory and hepatic failure at admission predicts mortality of severe scrub typhus patients: A prospective cohort study

Objective: To study the spectrum and outcome of severe scrub typhus in adult patients and to predict the hospital mortality by organ failure on admission.Methods: This was a prospective observational cohort study conducted between July 2017 and October 2020 at the medical emergency centre of PGIMER, Chandigarh, India. One hundred and twenty-six patients aged ≥13 years were diagnosed with scrub typhus. Severe disease was defined as the presence of organ failure based on the Sequential Organ Failure Assessment (SOFA) score on admission.Results: About two-thirds of the patients were from geographic regions outside the endemic sub-Himalayan belt. Fever (99.21%) and dyspnea (79.36%) were the most frequent complaints. Respiratory failure (81.75%) was the most common organ failure, followed by hepatic (52.38%), coagulative (47.62%), circulatory (33.33%), renal (21.43%), and cerebral dysfunction (13.49%). The median (Q1, Q3) SOFA score was 8 (6, 9), and 48.41% of the patients had a quick-SOFA score ≥2. Organ supports with invasive ventilation (40.48%), vasopressors (36.51%), and renal replacement therapy (7.14%) were frequently required. The in-hospital mortality was 11.90% and was independently predicted by circulatory and hepatic failures on multivariate logistic regression (OR 11.12, 95% CI 1.73-71.31 and OR 8.49, 95% CI 1.18-61.41, respectively).Conclusions: Most patients had pulmonary dysfunction; circulatory or hepatic failure on admission strongly predicts death.

414. Association of SARS-CoV-2 Genomic Load Trends with Clinical Status in COVID-19:A Retrospective Analysis from an Academic Hospital Center in New York City

BackgroundThe Infectious Diseases Society of America has identified the potential use of SARS-CoV-2 genomic load for prognostication purposes as a key research question.MethodsWe designed a retrospective cohort study that included adult patients with COVID-19 pneumonia who had at least 2 positive nasopharyngeal tests at least 24 hours apart to study the correlation between the change in the genomic load of SARS-CoV-2 in nasopharyngeal samples, as reflected by the Cycle threshold (Ct) value of the real-time Polymerase Chain Reaction (PCR) assay, with change in clinical status. The Sequential Organ Failure Assessment (SOFA) score was used as a surrogate for patients’ clinical status. A linear mixed-effects regression analysis was performed.ResultsAmong 457 patients who presented to the emergency department between 3/31/2020- 4/10/2020, we identified 42 patients who met the inclusion criteria. The median initial SOFA score was 2 (IQR 2–3). 20 out of 42 patients had a lower SOFA score on their subsequent tests. We identified a statistically significant inverse correlation between the change in SOFA score and change in the Ct value with a decrease in SOFA score by 0.05 (SE 0.02; p < 0.05) for an increase in Ct values by 1. This correlation was independent of the duration of symptoms.Flow chart A graph of the Cycle Threshold (Ct) values of the of Cepheid Xpert® Xpress SARS-CoV-2 assay measured on repeat screening of the 42 included patients. Graph of the fitted SOFA scores based on the Cycle Threshold values per patient. ConclusionOur findings suggest that an increasing Ct value in sequential tests may be of prognostic value for patients diagnosed with COVID-19 pneumonia. Before repeat testing can be recommended routinely in clinical practice as a predictor of disease outcomes, prospective studies with a standardized interval between repeat tests should confirm our findings.Disclosures All Authors: No reported disclosures