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Organ Dysfunction Scores in the Adult ICU

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Annual Update in Intensive Care and Emergency Medicine 2023

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM))

Abstract

Standardized assessments of organ dysfunction in critically ill patients have multiple uses and implications in current clinical and research practice, including prognostication, describing trajectory of illness, screening patients at risk, and as outcomes in current research. Since the development of the scoring systems currently in use, several aspects of clinical practice have evolved, raising the question as to whether existing scores need updating. Multiple criteria (e.g., simplicity, availability, reliability, specificity) should be met when selecting variables for organ dysfunction scores, but ideal variables are difficult to find. Therefore, after careful analysis of large cohorts, a broad consensus including some compromise is likely to be required if updates are to be undertaken. Application of existing organ dysfunction scores as dynamic tools to assist in guiding treatment decisions rather than as tools for prognostication requires further attention and study.

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References

  1. Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest. 1992;101:1644–55.

    Article  CAS  PubMed  Google Scholar 

  2. Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021;49:e1063–143.

    Article  PubMed  Google Scholar 

  3. Goris RJA. Mediators of multiple organ failure. Intensive Care Med. 1990;16:S192–6.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Tran DD, Groeneveld AB, van der Meulen J, Nauta JJ, Strack van Schijndel RJ, Thijs LG. Age, chronic disease, sepsis, organ system failure, and mortality in a medical intensive care unit. Crit Care Med. 1990;18:474–9.

    Article  CAS  PubMed  Google Scholar 

  5. Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23:1638–52.

    Article  CAS  PubMed  Google Scholar 

  6. Le Gall JR, Klar J, Lemeshow S, et al. The Logistic Organ Dysfunction system. A new way to assess organ dysfunction in the intensive care unit. ICU Scoring Group. JAMA. 1996;276:802–10.

    Article  PubMed  Google Scholar 

  7. Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med. 1996;22:707–10.

    Article  CAS  PubMed  Google Scholar 

  8. Khwannimit B. A comparison of three organ dysfunction scores: MODS, SOFA and LOD for predicting ICU mortality in critically ill patients. J Med Assoc Thai. 2007;90:1074–81.

    PubMed  Google Scholar 

  9. Vincent JL, de Mendonça A, Cantraine F, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26:1793–800.

    Article  CAS  PubMed  Google Scholar 

  10. Vincent JL, Moreno R. Clinical review: scoring systems in the critically ill. Crit Care. 2010;14:207.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Blanco J, Muriel-Bombín A, Sagredo V, et al. Incidence, organ dysfunction and mortality in severe sepsis: a Spanish Multicentre Study. Crit Care. 2008;12:R158.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Chierego M, Verdant C, De Backer D. Microcirculatory alterations in critically ill patients. Minerva Anestesiol. 2006;72:199–205.

    CAS  PubMed  Google Scholar 

  13. Nakashima T, Miyamoto K, Shimokawa T, Kato S, Hayakawa M. The association between sequential organ failure assessment scores and mortality in patients with sepsis during the first week: the JSEPTIC DIC Study. J Intensive Care Med. 2020;35:656–62.

    Article  PubMed  Google Scholar 

  14. Soo A, Zuege DJ, Fick GH, et al. Describing organ dysfunction in the intensive care unit: a cohort study of 20,000 patients. Crit Care. 2019;23:186.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Raith EP, Udy AA, Bailey M, et al. Prognostic accuracy of the SOFA score, SIRS Criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA. 2017;317:290–300.

    Article  PubMed  Google Scholar 

  16. Khwannimit B, Bhurayanontachai R, Vattanavanit V. Comparison of the performance of SOFA, qSOFA, and SIRS for predicting mortality and organ failure among sepsis patients admitted to the intensive care unit in a middle-income country. J Crit Care. 2018;44:156–60.

    Article  PubMed  Google Scholar 

  17. Keller MB, Wang J, Nason M, Warner S, Follmann D, Kadri SS. Preintubation sequential organ failure assessment score for predicting COVID-19 mortality: external validation using electronic health record from 86 U.S. healthcare systems to appraise current ventilator triage algorithms. Crit Care Med. 2022;50:1051–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Gelissen H, de Grooth HJ, Smulders Y, et al. Effect of low-normal vs high-normal oxygenation targets on organ dysfunction in critically ill patients: a randomized clinical trial. JAMA. 2021;326:940–8.

    Article  CAS  PubMed  Google Scholar 

  19. de Grooth HJ, Geenen IL, Girbes AR, Vincent JL, Parienti JJ, Oudemans-van Straaten HM. SOFA and mortality endpoints in randomized controlled trials: a systematic review and meta-regression analysis. Crit Care. 2017;21:38.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Xu Z, Mao C, Su C, et al. Sepsis subphenotyping based on organ dysfunction trajectory. Crit Care. 2022;26:197.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Liu Y, Gao K, Deng H, et al. A time-incorporated SOFA score-based machine learning model for predicting mortality in critically ill patients: a multicenter, real-world study. Int J Med Inform. 2022;163:104776.

    Article  PubMed  Google Scholar 

  22. Zieleskiewicz L, Muller L, Lakhal K, et al. Point-of-care ultrasound in intensive care units: assessment of 1073 procedures in a multicentric, prospective, observational study. Intensive Care Med. 2015;41:1638–47.

    Article  PubMed  Google Scholar 

  23. Vasilevskis EE, Pandharipande PP, Graves AJ, et al. Validity of a modified sequential organ failure assessment score using the Richmond Agitation-Sedation Scale. Crit Care Med. 2016;44:138–46.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Yadav H, Harrison AM, Hanson AC, Gajic O, Kor DJ, Cartin-Ceba R. Improving the accuracy of cardiovascular component of the sequential organ failure assessment score. Crit Care Med. 2015;43:1449–57.

    Article  PubMed  Google Scholar 

  25. Szczeklik W, Fronczek J. Should we revise the SOFA score? Yes. Acta Anaesthesiol Scand. 2022;66:658–9.

    Article  PubMed  Google Scholar 

  26. Bachmann KF, Arabi YM, Regli A, Starkopf J, Reintam BA. Cardiovascular SOFA score may not reflect current practice. Intensive Care Med. 2022;48:119–20.

    Article  PubMed  Google Scholar 

  27. Pölkki A, Pekkarinen PT, Takala J, Selander T, Reinikainen M. Association of Sequential Organ Failure Assessment (SOFA) components with mortality. Acta Anaesthesiol Scand. 2022;66:731–41.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Bosch NA, Teja B, Wunsch H, Walkey AJ. Characterization and validation of a novel measure of septic shock severity. Intensive Care Med. 2020;46:135–7.

    Article  PubMed  Google Scholar 

  29. Vallabhajosyula S, Jentzer JC, Kotecha AA, et al. Development and performance of a novel vasopressor-driven mortality prediction model in septic shock. Ann Intensive Care. 2018;8:112.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hernández G, Ospina-Tascón GA, Damiani LP, et al. Effect of a resuscitation strategy targeting peripheral perfusion status vs serum lactate levels on 28-day mortality among patients with septic shock. JAMA. 2019;321:654.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Garcia MA, Rucci JM, Thai KK, et al. Association between troponin i levels during sepsis and postsepsis cardiovascular complications. Am J Respir Crit Care Med. 2021;204:557–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Attinger-Toller A, Bossard M, Cioffi GM, et al. Ventricular unloading using the Impella(TM) device in cardiogenic shock. Front Cardiovasc Med. 2022;9:856870.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Lee BY, Lee S-I, Baek MS, et al. Lower driving pressure and neuromuscular blocker use are associated with decreased mortality in patients with COVID-19 ARDS. Respir Care. 2022;67:216–26.

    Article  PubMed  Google Scholar 

  34. Lecompte-Osorio P, Pearson SD, Pieroni CH, et al. Bedside estimates of dead space using end-tidal CO2 are independently associated with mortality in ARDS. Crit Care. 2021;25:333.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Akca S, Haji-Michael P, de Mendonça A, Suter P, Levi M, Vincent JL. Time course of platelet counts in critically ill patients. Crit Care Med. 2002;30:753–6.

    Article  PubMed  Google Scholar 

  36. Liang P, Yu F. Value of CRP, PCT, and NLR in prediction of severity and prognosis of patients with bloodstream infections and sepsis. Front Surg. 2022;9:857218.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Tajarernmuang P, Phrommintikul A, Limsukon A, Pothirat C, Chittawatanarat K. The role of mean platelet volume as a predictor of mortality in critically ill patients: a systematic review and meta-analysis. Crit Care Res Prac. 2016;2016:1–8.

    Article  Google Scholar 

  38. Jhang WK, Kim YA, Ha EJ, et al. Extrarenal sequential organ failure assessment score as an outcome predictor of critically ill children on continuous renal replacement therapy. Pediatr Nephrol. 2014;29:1089–95.

    Article  PubMed  Google Scholar 

  39. Pan HC, Jenq CC, Tsai MH, et al. Scoring systems for 6-month mortality in critically ill cirrhotic patients: a prospective analysis of chronic liver failure—sequential organ failure assessment score (CLIF-SOFA). Aliment Pharmacol Ther. 2014;40:1056–65.

    Article  PubMed  Google Scholar 

  40. Marshall JC. Measuring organ dysfunction. Med Klin Intensivmed Notfmed. 2020;115(Suppl 1):15–20.

    Article  CAS  PubMed  Google Scholar 

  41. Reintam Blaser A, Padar M, Mändul M, et al. Development of the Gastrointestinal Dysfunction Score (GIDS) for critically ill patients—a prospective multicenter observational study (iSOFA study). Clin Nutr. 2021;40:4932–40.

    Article  CAS  PubMed  Google Scholar 

  42. Reintam Blaser A, Regli A, De Keulenaer B, et al. Incidence, risk factors, and outcomes of intra-abdominal hypertension in critically ill patients—a prospective multicenter study (IROI Study). Crit Care Med. 2019;47:535–42.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Regli A, Reintam Blaser A, De Keulenaer B, et al. Intra-abdominal hypertension and hypoxic respiratory failure together predict adverse outcome—a sub-analysis of a prospective cohort. J Crit Care. 2021;64:165–72.

    Article  PubMed  Google Scholar 

  44. Aperstein Y, Cohen L, Bendavid I, et al. Improved ICU mortality prediction based on SOFA scores and gastrointestinal parameters. PLoS One. 2019;14:e0222599.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Reintam Blaser A, van Zanten ARH, de Man AME. Electrolytes in the ICU. In: Vincent JL, editor. Annual Update in Intensive Care and Emergency Medicine 2022. Heidelberg: Springer; 2022. p. 183–200.

    Chapter  Google Scholar 

  46. Grissom CK, Brown SM, Kuttler KG, et al. A modified sequential organ failure assessment score for critical care triage. Disaster Med Public Health Prep. 2010;4:277–84.

    Article  PubMed  Google Scholar 

  47. Vacheron CH, Friggeri A, Iwaz J, et al. A new simplified and accurate sa-SOFA score. J Crit Care. 2020;57:240–5.

    Article  PubMed  Google Scholar 

  48. Lee KS, Sheen SS, Jung YJ, et al. Consideration of additional factors in Sequential Organ Failure Assessment score. J Crit Care. 2014;29:185.e189–185.e12.

    Article  Google Scholar 

  49. Knox DB, Lanspa MJ, Pratt CM, Kuttler KG, Jones JP, Brown SM. Glasgow Coma Scale score dominates the association between admission Sequential Organ Failure Assessment score and 30-day mortality in a mixed intensive care unit population. J Crit Care. 2014;29:780–5.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Kawasaki T, Shime N, Straney L, et al. Paediatric sequential organ failure assessment score (pSOFA): a plea for the world-wide collaboration for consensus. Intensive Care Med. 2018;44:995–7.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia

    A. Reintam Blaser & K. F. Bachmann

  2. Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland

    A. Reintam Blaser & K. F. Bachmann

  3. Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

    Y. M. Arabi

Authors
  1. A. Reintam Blaser
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  2. K. F. Bachmann
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  3. Y. M. Arabi
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Correspondence to A. Reintam Blaser .

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Editors and Affiliations

  1. Department of Intensive Care, Erasme University Hospital Université libre de Bruxelles, Brussels, Belgium

    Jean-Louis Vincent

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Reintam Blaser, A., Bachmann, K.F., Arabi, Y.M. (2023). Organ Dysfunction Scores in the Adult ICU. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2023. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-031-23005-9_8

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  • DOI: https://doi.org/10.1007/978-3-031-23005-9_8

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  • Online ISBN: 978-3-031-23005-9

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