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SOFA score in septic patients: incremental prognostic value over age, comorbidities, and parameters of sepsis severity

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Abstract

Several widely used scoring systems for septic patients have been validated in an ICU setting, and may not be appropriate for other settings like Emergency Departments (ED) or High-Dependency Units (HDU), where a relevant number of these patients are managed. The purpose of this study is to find reliable tools for prognostic assessment of septic patients managed in an ED-HDU. In 742 patients diagnosed with sepsis/severe sepsis/septic shock, not-intubated, admitted in ED between June 2008 and April 2016, SOFA, qSOFA, PIRO, MEWS, Charlson Comorbidity Index, MEDS, and APACHE II were calculated at ED admission (T0); SOFA and MEWS were also calculated after 24 h of ED-High-Dependency Unit stay (T1). Discrimination and incremental prognostic value of SOFA score over demographic data and parameters of sepsis severity were tested. Primary outcome is 28-day mortality. Twenty-eight day mortality rate is 31%. The different scores show a modest-to-moderate discrimination (T0 SOFA 0.695; T1 SOFA 0.741; qSOFA 0.625; T0 MEWS 0.662; T1 MEWS 0.729; PIRO: 0.646; APACHE II 0.756; Charlson Comorbidity Index 0.596; MEDS 0.674, all p < 0.001). At a multivariate stepwise Cox analysis, including age, Charlson Comorbidity Index, MEWS, and lactates, SOFA shows an incremental prognostic ability both at T0 (RR 1.165, IC 95% 1.009–1.224, p < 0.0001) and T1 (RR 1.168, IC 95% 1.104–1.234, p < 0.0001). SOFA score shows a moderate prognostic stratification ability, and demonstrates an incremental prognostic value over the previous medical conditions and clinical parameters in septic patients.

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Authors and Affiliations

  1. High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy

    Francesca Innocenti, Camilla Tozzi, Chiara Donnini, Eleonora De Villa, Alberto Conti, Maurizio Zanobetti & Riccardo Pini

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  1. Francesca Innocenti
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  2. Camilla Tozzi
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  3. Chiara Donnini
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  4. Eleonora De Villa
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  6. Maurizio Zanobetti
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Correspondence to Francesca Innocenti.

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The study is consistent with the principles of the Declaration of Helsinki of clinical research involving human subjects.

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Informed consent was obtained from all individual participants included in the study when they were called for follow-up.

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Innocenti, F., Tozzi, C., Donnini, C. et al. SOFA score in septic patients: incremental prognostic value over age, comorbidities, and parameters of sepsis severity. Intern Emerg Med 13, 405–412 (2018). https://doi.org/10.1007/s11739-017-1629-5

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