SOFA score in septic patients: incremental prognostic value over age, comorbidities, and parameters of sepsis severity
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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.
KeywordsSepsis Vital signs Lactate Prognostic scores Organ dysfunction scores
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Statement of human and animal rights
The study is consistent with the principles of the Declaration of Helsinki of clinical research involving human subjects.
Informed consent was obtained from all individual participants included in the study when they were called for follow-up.
- 4.Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb S, Beale RJ, Vincent JL, Moreno R (2013) Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012. Intensive Care Med 39:165–228CrossRefPubMedGoogle Scholar
- 5.Cardoso T, Carneiro AH, Ribeiro O, Teixeira-Pinto A, Costa-Pereira A (2010) Reducing mortality in severe sepsis with the implementation of a core 6-hour bundle: results from the Portuguese community-acquired sepsis study (SACiUCI study). Critical Care 14(3):R83. doi: 10.1186/cc9008 CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Vincent JL, Moreno R, Takala J, Willatts S, De MA, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710CrossRefPubMedGoogle Scholar
- 10.Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC (2016) The Third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 315:801–810CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Timsit JF, Fosse JP, Troche G, De LA, Alberti C, Garrouste-Org Azoulay E, Chevret S, Moine P, Cohen Y (2001) Accuracy of a composite score using daily SAPS II and LOD scores for predicting hospital mortality in ICU patients hospitalized for more than 72 h. Intensive Care Med 27:1012–1021CrossRefPubMedGoogle Scholar
- 19.Jansen TC, van Bommel J, Woodward R, Mulder PG, Bakker J (2009) Association between blood lactate levels, Sequential Organ Failure Assessment subscores, and 28-day mortality during early and late intensive care unit stay: a retrospective observational study. Crit Care Med 37:2369–2374CrossRefPubMedGoogle Scholar
- 27.Nguyen HB, Loomba M, Yang JJ, Jacobsen G, Shah K, Otero RM, Suarez A, Parekh H, Jaehne A, Rivers EP (2010) Early lactate clearance is associated with biomarkers of inflammation, coagulation, apoptosis, organ dysfunction and mortality in severe sepsis and septic shock. J Inflamm (Lond) 7:6CrossRefGoogle Scholar
- 30.Hilderink MJ, Roest AA, Hermans M, Keulemans YC, Stehouwer CD, Stassen PM (2014) Predictive accuracy and feasibility of risk stratification scores for 28-day mortality of patients with sepsis in an emergency department. Eur J Emerg Med 22(5):331–337. doi: 10.1097/MEJ.0000000000000185
- 31.Nguyen HB, Van GC, Batech M, Banta J, Corbett SW (2012) Comparison of predisposition, insult/infection, response, and organ dysfunction, acute physiology and chronic health evaluation II, and Mortality in Emergency Department Sepsis in patients meeting criteria for early goal-directed therapy and the severe sepsis resuscitation bundle. J Crit Care 27:362–369CrossRefPubMedGoogle Scholar
- 33.Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, Rubenfeld G, Kahn JM, Shankar-Hari M, Singer M, Deutschman CS, Escobar GJ, Angus DC (2016) Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 315:762–774CrossRefPubMedPubMedCentralGoogle Scholar