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Value of the SOFA score as a predictive model for short-term survival in high-risk liver transplant recipients with a pre-transplant labMELD score ≥30

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Abstract

Introduction

The Sequential Organ Failure Assessment (SOFA) score has been applied for the prediction of survival in critically ill patients. We analysed the value of the SOFA score for the prediction of short-term survival after liver transplantation in high-risk liver transplant recipients with a labMELD score ≥30.

Patients and methods

We conducted a retrospective single-centre analysis including 88 consecutive liver transplants in adults between January 1, 2007 and December 31, 2010 with a pre-transplant labMELD score ≥30. The SOFA score was assessed preoperatively, directly after transplantation and on post-operative days (PODs) 1–10. Combined and living-related liver transplants were excluded. Receiver operating characteristic (ROC) curve analysis with the Hosmer–Lemeshow test and application of the Brier score were used to calculate sensitivity, specificity, overall model correctness and calibration. Cutoff values were selected with the best Youden index.

Results

ROC curve analysis showed areas under the curve (AUROCs) >0.8 for the SOFA score on PODs 1–10 for the prediction of hospital mortality, 30-day mortality and 3-month mortality with Hosmer–Lemeshow test results that confirmed good model calibration (p > 0.05). The Brier score demonstrated an accuracy of prediction (<0.25) of hospital mortality, 30-day mortality and 3-month mortality for the SOFA scores on PODs 4–9 indicating superior accuracy on PODs 7 and 8 with cutoff values for the SOFA score between 16.5 and 18.5. The pre-transplant SOFA score failed to reach AUROCs >0.7 (0.603–0.663) for the prediction of short-term survival.

Conclusions

Our results confirm the usefulness of the SOFA score in high-risk liver recipients during the early post-operative course, especially on PODs 7–8 for the prediction of hospital mortality, 30-day mortality and 3-month mortality and may be useful to predict futile early acute retransplantation.

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Acknowledgements

The authors would like to thank Dr. Hoy, Department of Biometry at the Medizinische Hochschule Hannover for his support and critical review of the manuscript.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, Medizinische Hochschule Hannover, Hannover, Germany

    Harald Schrem, Benedikt Reichert, Frank Lehner, Moritz Kleine, Hüseyin Bektas & Jürgen Klempnauer

  2. Ear, Nose and Throat, Johannes Wesling Klinikum Minden, Minden, Germany

    Melanie Reichert

  3. Department of General and Thoracic Surgery, Universitätsklinikum Schleswig Holstein, Kiel, Germany

    Thomas Becker

  4. Department of Anaesthesiology and Intensive Care Medicine, Medizinische Hochschule Hannover, Hannover, Germany

    Kai Johanning

  5. Department of Gastroenterology, Endocrinology and Hepatology, Medizinische Hochschule Hannover, Hannover, Germany

    Christian P. Strassburg

  6. Allgemein-, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Harald Schrem

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  1. Harald Schrem
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  2. Melanie Reichert
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  10. Jürgen Klempnauer
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Correspondence to Harald Schrem.

Additional information

Harald Schrem and Melanie Reichert contributed equally to this paper.

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Schrem, H., Reichert, M., Reichert, B. et al. Value of the SOFA score as a predictive model for short-term survival in high-risk liver transplant recipients with a pre-transplant labMELD score ≥30. Langenbecks Arch Surg 397, 717–726 (2012). https://doi.org/10.1007/s00423-011-0881-9

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