Sequential Organ Failure Assessment Scoring Systems Research Articles

Predictive Value of Multiple Scoring Systems in the Prognosis of Septic Patients with Different Infection Sites: Analysis of the Medical Information Mart for the Intensive Care IV Database.

The heterogeneity nature of sepsis is significantly impacted by the site of infection. This study aims to explore the predictive value of multiple scoring systems in assessing the prognosis of septic patients across different infection sites. Data for this retrospective cohort study were extracted from the Medical Information Mart for Intensive Care IV database (MIMIC-IV) (v2.2). Adult patients meeting the criteria for sepsis 3.0 and admitted to the intensive care unit (ICU) were enrolled. Infection sites included were pneumonia, urinary tract infection (UTI), cellulitis, abdominal infection, and bacteremia. The primary outcome assessed was 28-day mortality. The sequential Organ Failure Assessment (SOFA) score, Oxford Acute Severity of Illness Score (OASIS), and Logistic Organ Dysfunction System (LODS) score were compared. Binomial logistic regression analysis was conducted to evaluate the association between these variables and mortality. Additionally, differences in the area under the curve (AUC) of receiver operating characteristic (ROC) among the scoring systems were analyzed. A total of 4721 patients were included in the analysis. The average 28-day mortality rate was 9.4%. Significant differences were observed in LODS, OASIS, and SOFA scores between the 28-day survival and non-survival groups across different infection sites (p < 0.01). In the pneumonia group and abdominal infection group, both the LODS and OASIS scoring systems emerged as independent risk factors for mortality in septic patients (odds ratio [OR]: 1.165, 95% confidence interval [CI]: 1.109-1.224, p < 0.001; OR: 1.047, 95% CI: 1.028-1.065, p < 0.001) (OR: 1.200, 95% CI: 1.091-1.319, p < 0.001; OR: 1.060, 95% CI: 1.025-1.095, p < 0.001). For patients with UTI, the LODS, OASIS, and SOFA scoring systems were identified as independent risk factors for mortality (OR: 1.142, 95% CI: 1.068-1.220, p < 0.001; OR: 1.062, 95% CI: 1.037-1.087, p < 0.001; OR: 1.146, 95% CI: 1.046-1.255, p = 0.004), with the AUC of LODS score and OASIS significantly higher than that of the SOFA score (p = 0.006). Among patients with cellulitis, the OASIS and SOFA scoring systems were identified as independent risk factors for mortality (OR: 1.055, 95% CI: 1.007-1.106, p = 0.025; OR: 1.187, 95% CI: 1.005-1.403, p = 0.044), with no significant difference in prognosis prediction observed (p = 0.243). In the bacteremia group, the LODS scoring system was identified as an independent risk factor for mortality (OR: 1.165, 95% CI: 1.109-1.224, p < 0.001). The findings suggest that LODS scores offer better prognostic accuracy for predicting the mortality risk in septic patients with pneumonia, abdominal infections, bacteremia, and UTI compared to SOFA scores.

Evaluation of the new poisoning mortality score in comparison with PSS and SOFA scoring systems to predict mortality in poisoned patients admitted to the intensive care unit.

Mortality prediction in acute poisoning patients aids in prompt and effective treatment. This study aimed to evaluate the effectiveness of the new Poisoning Mortality Score (PMS) in comparison with the Poison Severity Score (PSS) and Sequential Organ Failure Assessment (SOFA) scoring systems in poisoned patients admitted to the intensive care unit (ICU). The medical records of 523 poisoned patients admitted to the ICU of the Poison Control Centre from September 2021 to June 2022 were examined retrospectively. The PMS, PSS, and SOFA scores were calculated based on the worst values of the first 24 h of admission. A total of 100 patients were enrolled in the study, and the in-hospital mortality rate was 28%. The best cut-off points for predicting mortality for PMS, PSS, and SOFA scores were > 53, > 2, and > 6, with sensitivities of 67.9%, 85.7%, and 82.4% and specificities of 73.6%, 84.7%, and 83.3% respectively. In a pairwise comparison of the AUCs for PMS, PSS, and SOFA scores, SOFA displayed significantly greater accuracy than PSS and PMS. The PMS, PSS, and SOFA scoring systems were significant predictors of mortality in ICU-admitted poisoned patients, however, the SOFA score showed the best performance (OR = 1.77, and 95% CI = 1.42-2.54) with significant P-value (0.002) as a predictor of mortality and highest AUC(0.904).

One-year mortality prediction for patients with sepsis: a nomogram integrating lactic dehydrogenase and clinical characteristics

BackgroundTo explore the association between myocardial enzymes and one-year mortality, and establish a nomogram integrating myocardial enzymes and clinical characteristics to predict one-year mortality among sepsis patients.MethodsData of 1,983 sepsis patients were extracted from Medical Information Mart for Intensive Care III database in this retrospective cohort study. All participants were randomly split into the training set for the development of model and testing set for the internal validation at the ratio of 7:3. Univariate logistic regression was used to screen variables with statistical differences which were made for stepwise regression, obtaining the predictors associated with one-year mortality of sepsis patients. Adopted multivariate logistic regression to assess the relationship between myocardial enzymes and one-year mortality of sepsis patients. A nomogram was established in predicting the one-year survival status of sepsis patients, and the performance of developed model were compared with LDH alone, sequential organ failure assessment (SOFA), simplified acute physiology score II (SAPS II) by receiver operator characteristic, calibration, and decision curves analysis.ResultsThe result found that LDH was associated with one-year mortality of sepsis patients [odds ratio = 1.28, 95% confidence interval (CI): 1.18–1.52]. Independent predictors, including age, gender, ethnicity, potassium, calcium, albumin, hemoglobin, alkaline phosphatase, vasopressor, Elixhauser score, respiratory failure, and LDH were identified and used to establish the nomogram (LDH-model) for predicting one-year mortality for sepsis patients. The predicted performance [area under curve (AUC) = 0.773, 95%CI: 0.748–0.798] of this developed nomogram in the training and testing sets (AUC = 0.750, 95%CI: 0.711–0.789), which was superior to that of LDH alone, SOFA score, SAPS II score. Additionally, calibration curve indicated that LDH-model may have a good agreement between the predictive and actual outcomes, while decision curve analysis demonstrated clinical utility of the LDH-model.ConclusionLDH level was related to the risk of one-year mortality in sepsis patients. A prediction model based on LDH and clinical features was developed to predict one-year mortality risk of sepsis patients, surpassing the predictive ability of LDH alone as well as conventional SAPS II and SOFA scoring systems.

Comparison of Sensitivity, Specificity and Accuracy of APACHE II, SAPS II and SOFA Scoring Systems as Predictors

Aim: To compare the APACHE II, SAPS II and SOFA scoring systems as predictors of mortality in ICU patients in terms of sensitivity, specificity and accuracy. Methodology: A prospective observational study. Intensive care unit from May 13, 2018 to September 15, 2021. For 1368 patients included in study, results for APACHE II, SAPS II and SOFA were calculated with the worst values recorded. At the end of ICU stay, patient outcome was labelled as survivors and non-survivors. The cut off value for APACHE II, SAPS II and SOFA was taken as 50% of the highest possible score, with &lt;50% expected to survive and with ≥50% expected to die during their ICU stay. Cross tables were made against real outcome of the patients, and sensitivity, specificity and accuracy for APACHE II, SAPS II and SOFA were calculated. Results: Sensitivity, specificity and accuracy were 77.53%, 94.28% and 85.45% for APACHE II scoring system; 47.29%, 87.32%, and 66.23% for SAPS II scoring system; and 73.37%, 60.28%, and 67.18% for SOFA scoring system, respectively. Conclusion: Apache Ii scoring system has highest sensitivity, specificity and accuracy in mortality prediction in ICU patients as compared to SAPS II and SOFA scoring systems, with SAPS II being least sensitive and accurate. Keywords: Sensitivity, specificity, accuracy, Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS II), Sequential Organ Failure Assessment (SOFA), Intensive care units (ICU), Mortality.

Role of qSOFA and SOFA Scoring Systems for Predicting In-Hospital Risk of Deterioration in the Emergency Department.

The objective of this study was to analyze and compare the usefulness of quick sequential organ failure assessment score (qSOFA) and sequential organ failure assessment (SOFA) scores for the detection of early (two-day) mortality in patients transported by emergency medical services (EMSs) to the emergency department (ED) (infectious and non-infectious). We performed a multicentric, prospective and blinded end-point study in adults transported with high priority by ambulance from the scene to the ED with the participation of five hospitals. For each score, the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was calculated. We included 870 patients in the final cohort. The median age was 70 years (IQR 54–81 years), and 338 (38.8%) of the participants were women. Two-day mortality was 8.3% (73 cases), and 20.9% of cases were of an infectious pathology. For two-day mortality, the qSOFA presented an AUC of 0.812 (95% CI: 0.75–0.87; p < 0.001) globally with a sensitivity of 84.9 (95% CI: 75.0–91.4) and a specificity of 69.4 (95% CI: 66.1–72.5), and a SOFA of 0.909 (95% CI: 0.86–0.95; p < 0.001) with sensitivity of 87.7 (95% CI: 78.2–93.4) and specificity of 80.7 (95% CI: 77.4–83.3). The qSOFA score can serve as a simple initial assessment to detect high-risk patients, and the SOFA score can be used as an advanced tool to confirm organ dysfunction.

The Prognostic Potential of Three Scoring Systems for Mortality Prediction in the Intensive Care Unit: A systematic review and meta-analysis

Background: The predictive potential of scoring systems used in intensive care units (ICUs) to distinguish patients’ mortality is heavily investigated but scarcely pooled. Objectives: To statistically analyze the accuracy of three ICU generic scores, including Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS II), and Sequential Organ Failure Assessment (SOFA), to predict mortality. Methods: A meta-analysis was conducted involving prospective studies published between January 2000 and February 2019 to analyze the performance of APACHE II, SAPS II, and SOFA to predict patients’ mortality through pooling their discriminative indicators, such as sensitivity specificity, and the area under the hierarchical summary receiver operating characteristic curve (HSROC). The inconsistency index (I²) was used to assess heterogeneity in sensitivity and specificity, while meta-regression analysis was performed to detect the potential sources of heterogeneity. Deek’s funnel plots were used to assess the potential publication bias. Results: In a total of 37 studies (7612 patients, 63.58% males, 75.7% assessed in-hospital mortality), 2170 observed deaths were reported. APACHE II, SAPS II, and SOFA scoring systems showed good mortality predictive performances, where the pooled sensitivities were 0.81, 0.76, and 0.80, respectively, specificities were 0.78, 0.89, and 0.79, respectively, and pooled HSROCs were 0.87, 0.85, and 0.88, respectively. For APACHE II, SAPS II, and SOFA, there were significant in-between study heterogeneities in sensitivity (I²=85.21%, 84.31%, and 71.67%, respectively) and specificity (I²=93.74%, 92.65%, and 89.41%, respectively) while no publication bias was detected (P=0.689, 0.465, and 0.181, respectively). There was significant heterogeneity among studies that investigated APACHE II with a cut-off score of > 20 (P = 0.04) and those investigating SAPS II for > 24 months (P < .001). Conclusion: Within the limitations of the study, ICU scores showed good prognostic performance. Future studies should be conducted using fixed-time endpoints of mortality, involving multiple countries and employ a combination of generic ICU scores.

Assessment of the diagnostic ability of RIFLE and SOFA scoring systems in comparison with protein biomarkers in acute kidney injury

Abstract Background We aimed to assess the diagnostic sensitivity of Risk, Injury, Failure, Loss, and End-stage (RIFLE) and Sequential Organ Failure Assessment (SOFA) scoring systems regarding the serum creatinine level in acute kidney injury (AKI) patients hospitalized in the intensive care unit (ICU). This study also aims to compare the sensitivity of these scoring systems with that of mitochondrial pyruvate carrier 1 (MPC-1), interleukin-10 (IL-10) and neutrophil gelatinase-associated lipocalin (NGAL) as biomarkers. Methods This is a cross-sectional study. Thirty patients with increased creatinine level and decreased urine output were recognized as AKI patients, and 30 patients were selected as the control group. The serum levels of each of the proteins of interest were measured at the initial state (moment of entrance) and final state (14th day in the ICU). Statistical analysis was performed with respect to t-test, and a p-value &lt; 0.05 was considered significant. The diagnostic ability of biomarkers was assessed using receiver operating characteristic (ROC) curve. Results The majority of patients were recognized in the risk level of RIFLE, and level 1 of SOFA scoring system. There was no correlation between RIFLE and SOFA (p = 0.123). The expression of MPC-1, IL-10 and NGAL was more remarkable compared with the serum creatinine level. The ROC area change for MPC-1 and IL-10 was higher compared with that for NGAL. As a result, MPC-1 and IL-10 are more reliable biomarkers than NGAL to predict the incidence of AKI in the earlier stage. Conclusions There was no significant correlation between SOFA and RIFLE classification, and also the sensitivity of these scoring systems was identified at the risk level for AKI patients. Instead, the level of biomarkers alters earlier, and in higher concentration, than creatinine and urine output changes; therefore, they are more reliable than RIFLE and SOFA scoring systems for prognosis purposes.

Efficacy and accuracy of qSOFA and SOFA scores as prognostic tools for community-acquired and healthcare-associated pneumonia

BackgroundThe Japanese Respiratory Society recently updated its prognostic guidelines for pneumonia, recommending that pneumonia severity be evaluated using the sequential organ failure assessment (SOFA) and quick SOFA (qSOFA) scoring systems in a therapeutic strategy flowchart. However, the efficacy and accuracy of these tools are still unknown. MethodsAll patients with community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP) who were admitted to the study institution between 2014 and 2017 were enrolled in this study. Pneumonia severity on admission was evaluated by A-DROP, CURB-65, PSI, I-ROAD, qSOFA, and SOFA scoring systems. Prognostic factors for 30-day mortality were also analyzed. ResultsThis study included 406 patients, 257 male (63%) and 149 female (37%). The median age was 79 years (range 19–103 years). The 30-day and in-hospital mortality rates were both 5%. With respect to the diagnostic value of the predictive assessments for 30-day mortality, the area under the receiver operating characteristic curve (AUROC) value for the SOFA score was 0.769 for CAP patients and 0.774 for HCAP patients. Further, the AUROC values for the SOFA score in CAP and HCAP patients with a qSOFA score ≥2 were 0.829 and 0.784, respectively, for 30-day mortality. ConclusionsqSOFA and SOFA scores were able to correctly evaluate the severity of CAP and HCAP.

Comparison of APACHE II, SAPS II and SOFA Scoring Systems as Predictors of Mortality in ICU Patients

Objective: The comparison of the APACHE II, SAPS II and SOFA scoring systems as predictors of mortality in ICU patients. Study Design: A prospective observational study. Place and Duration of Study: Intensive care unit of Ch. Pervaiz Ellahi Institute of Cardiology and Nishtar Medical University and Hospital, Multan, from May 13, 2018 to September 24, 2018. Methodology: For 36 patients included in study, results for APACHE II, SAPS II and SOFA were calculated with the worst values recorded. At the end of ICU stay, patient outcome was labelled as survivors and non-survivors. Data was analyzed with SPSS v.23. Descriptive data was stated as median (minimum-maximum) or percentages. Pearson Chi square test and non-parametric statistics were applied accordingly. Linear regression analysis was also performed. Cut off value for statistical significance was taken as ≤0.05. Results: Of 36 patients, 22 survived and 14 died after being observed for 12 (2-17) days. On linear regression analysis, all the scoring systems were significantly associated with the mortality rates (p<0.05). However, after adjustment, only the APACHE II was a significant predictor of mortality (p<0.001). APACHE II scoring system calculated highest estimated mortality rates i.e. 19.3%, while SAPS II and SOFA scoring systems estimated 8.6% and 13.5% mortality, respectively. Conclusion: APACHE II scoring system was much superior to SAPS II and SOFA scoring systems as a significant predictor of the mortality among the ICU patients. Keywords: Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS II), Sequential Organ Failure Assessment (SOFA), Intensive care units (ICU), Mortality. DOI : 10.7176/JMPB/53-03 Publication date :March 31 st 2019

Predictive performance of the SOFA and mSOFA scoring systems for predicting in-hospital mortality in the emergency department

BackgroundThe Sequential Organ Failure Assessment (SOFA) and modified SOFA (mSOFA) are risk stratification systems which incorporate respiratory, coagulatory, liver, cardiovascular, renal, and neurologic systems to quantify the overall severity of acute disorder in the intensive care unit. ObjectiveTo evaluate the prognostic performance of the SOFA and mSOFA scores at arrival for predicting in-hospital mortality in the emergency department (ED). MethodsAll adult patients with an Emergency Severity Index (ESI) of 1–3 in the ED of Imam Reza Hospital, northeast of Iran were included from March 2016 to March 2017. The predictive performance of the SOFA or mSOFA scores were expressed in terms of accuracy (Brier Score, BS and Brier Skill Score, BSS), discrimination (Area Under the Receiver Operating Characteristic Curve, AUC), and calibration. ResultsA total of 2205 patients (mean age 61.8 ± 18.5 years, 53% male) were included. The overall in-hospital mortality was 19%. For SOFA and mSOFA the BS was 0.209 and 0.192 and the BSS was 0.11 and 0.09, respectively. The estimated AUCs of SOFA and mSOFA models were 0.751 and 0.739, respectively. No significant difference was observed between the AUCs (P = 0.186). The Hosmer-Lemeshow test did not show that the predictions deviated from the true probabilities. Also, the calibration plots revealed good agreement between the actual and predicted probabilities. ConclusionThe SOFA and mSOFA scores demonstrated fair discrimination and good calibration in predicting in-hospital mortality when applied to ED. However, further external validation studies are needed before their use in routine clinical care.

Comparison of the Effectiveness of Sequential Organ Failure Assessment (SOFA) and Quick Sequential Organ Failure Assessment (qSOFA) in Predicting Mortality in Secondary Non-Traumatic Peritonitis Patients

Introduction. Peritonitis has a high mortality rate, SOFA is a scoring system that represents 6 organ functions namely respiration, blood coagulation, liver, cardiovascular, Central Nervous System, and Kidney the higher the SOFA score the higher the possibility of mortality, qSOFA is a new scoring , practical and has a strong predictive value.&#x0D; Method. This study was a diagnostic study in the form of a suitability test to assess the sensitivity, specificity, PPV and NPV, cut of points and the suitability of the SOFA and qSOFA scoring systems in predicting outcomes of patients with secondary peritonitis in RSMH Palembang.&#x0D; Results. Data processing was performed on 27 study subjects during November 2017-June 2018. SOFA prognosis test results with a cut-off point &gt;5 obtained a sensitivity of 84.2%, 100% specificity, PPV 73.68%, NPV 100%, prognosis test results qSOFA with a cut off point&gt; 2 Obtained a sensitivity of 91.7%, specificity of 100%, PPV 91.66%, NPV 80%,&#x0D; Conclusion.The qSOFA scoring system was more efficient than SOFA in predicting mortality

Evaluation of acute physiology and chronic health evaluation IV score and sequential organ failure assessment score in predicting outcome of patients in respiratory intensive care unit

Background Scoring systems in ICU allow assessment of severity of the disease and provide an estimate of in-hospital mortality. And they quantify the severity of illness for hospital and health care system administration. Objective The objective of this study was to detect the ability of acute physiology and chronic health evaluation (APACHE) IV score and sequential organ failure assessment (SOFA) score in predicting outcome of patients in respiratory intensive care unit (RICU). Patients and methods A prospective observational cohort study was performed at the RICU of Bab El-Sha’eria and Al-Hussein Al-Azhar University hospitals. The study includes all critically ill patients admitted to the RICU between November 2014 and November 2016. Data were collected from 100 patients (42 female and 58 male) consecutively admitted to the RICU (aged ≥18 years and ICU stay of ≤24 h). Mean of APACHE IV score, length of stay, and predicted mortality rate were calculated during the first 24 h. Mean of SOFA score and length of stay were calculated during the admission. Data were analyzed with SPSS versus version 15. Results In 100 patients, the observed mortality rate was 49%. The mean age in survived patients was 57.216±12.588 years and in nonsurvived patients was 62.694±10.304 years. APACHE IV score more than 81 was kept as cutoff point, with sensitivity of 81.6% and specificity of 80.4% with area under receiver operating characteristic curve of 0.841. SOFA score more than 7 was kept as cutoff point, with sensitivity of 95.9% and specificity of 100% with area under receiver operating characteristic curve of 0.997. Conclusion The mortality prediction by APACHE IV and SOFA scoring systems performs acceptably in our patients, and they can be used as performance assessment tools in our RICUs. Both scores showed good discrimination between survived and nonsurvived patients, with SOFA score being more accurate in predicting mortality than APACHE IV.

Predicting the Destiny after Severe Traumatic Brain Injury; Multi Organ Dysfunction Syndrome (MODS) or Sequential Organ Failure Assessment (SOFA)?

Purpose: To compare the outcome prediction ability of SOFA and MOD scoring systems, in the subset of ICU patients with severe traumatic brain injury. Materials and Methods: We performed a descriptive analytic study at Poursina hospital, a tertiary care trauma center. A number of 83 patients with severe traumatic brain injury who admitted to ICU between November 2012 and December 2013 were included. SOFA and MOD scores were calculated for each patient on a daily basis and areas under receiver operating characteristic curves were used to compare the discriminative ability of two scoring systems. Results: Out of 83 patients, 23 died (27.71%). AUROC curve for SOFA and MOD score were 0.514 and 0.510 respectively on admission, 0.587 and 0.512 on the second day of admission, 0.779 and 0.749 on the fourth day of admission and 0.978 and 0.824 after two weeks. Both systems were unreliable predictors of death for first 48 hours of admission. After 96 hours of admission, both systems represented an acceptable prediction ability, with no statistically significant difference between two tools (P value=0.850). In terms of outcome prediction, MOD scoring system performed good on fourteenth day with a significant difference when compared to excellent discriminant function of SOFA (P value=0.027). Conclusions: During the 48 hours of admission, none of scoring tools showed a reliable function of predicting the ICU mortality. They represented an acceptable discriminative ability after the fourth day of admission and better predictive ability after the fourteenth day of admission. After two weeks of admission, SOFA is superior to MODS in outcome prediction.