Current Utility of Sequential Organ Failure Assessment Score: A Literature Review and Future Directions

Kashyap, Rahul; Sherani, Khalid; Dutt, Taru; Gnanapandithan, Karthik; Sagar, Malvika; Vallabhajosyula, Saraschandra; Vakil, Abhay; Surani, Salim

doi:10.2174/1874306402115010001

Cited by 18 publications

(14 citation statements)

References 36 publications

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“…Propensity-score matching analysis pneumonia was assessed by the simplified CPIS (14)(15)(16) and the SOFA score (17)(18)(19) on the day of admission. Patients' comorbidities were evaluated by the CCI (20).…”

Section: Ia Group N=70mentioning

confidence: 99%

Efficacy and safety of adjunctive nebulized colistin sulfate for multidrug-resistant Gram-negative bacteria pneumonia: a retrospective comparative cohort study

Bao¹,

Tao²,

Tang³

et al. 2022

Ann Palliat Med

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Background: The incidence of multidrug-resistant Gram-negative bacteria (MDR-GNB) pneumonia has increased in the last decade. If antibiotics are given only through intravenous, the antibiotic concentrations in lung tissue will be insufficient. Recently, nebulized antibiotics have shown effectiveness as an adjunctive therapy with intravenous antibiotics for resistant strains. Therefore, the goal of this study was to assess the efficacy and safety of adjunctive nebulized colistin sulfate in combination with intravenous antibiotics in patients with MDR-GNB pneumonia.Methods: A total of 203 patients who were infected with MDR-GNB pneumonia were selected. Based on whether patients received nebulized colistin sulfate, patients were divided into 2 groups: the NCIA group (nebulized colistin sulfate in combination with intravenous antibiotics) and the IA group (intravenous antibiotics without nebulized colistin sulfate). After propensity score matching (PSM) analysis, we compared the efficacy in terms of favorable clinical outcomes, the bacteria detection rate, days of hospital stay, days of intensive care unit (ICU) stay, days of mechanical ventilation (MV), antipyretic time, days of antibiotic therapy, and 28-day all-cause mortality. Safety was also compared between groups.Results: A total of 116 patients met the criteria for evaluation, with 46 patients in the NCIA group and 70 patients in the IA group. After PSM, 31 patients were selected from each group. There were significant differences in favorable clinical outcomes on days 7 (67.7% vs. 32.3%, P=0.005) and 14 (71% vs. 41.9%, P=0.045) and the bacteria detection rate on days 7, 14, and the last day. There were also significant differences in days of hospital stay (17 vs. 23 days, P=0.01), antipyretic time (0.5 vs. 7.5 days, P=0.037), and days of antibiotic therapy (14 vs. 23 days, P=0.002). However, there were no significant differences in days of ICU stay, days of MV, and 28-day all-cause mortality. For nephrotoxicity, the NCIA group did not increase the risk of acute kidney injury (16.1% vs. 9.7%, P=0.707), only one patient (3.2%) in the NCIA group developed airway hyperresponsiveness (P=1.000).Conclusions: For MDR-GNB pneumonia, nebulized colistin sulfate as an adjuvant supportive treatment for intravenous antibiotics maybe can improve clinical efficacy and has high safety.

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Section: Ia Group N=70mentioning

confidence: 99%

Efficacy and safety of adjunctive nebulized colistin sulfate for multidrug-resistant Gram-negative bacteria pneumonia: a retrospective comparative cohort study

Bao¹,

Tao²,

Tang³

et al. 2022

Ann Palliat Med

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“…Kashyap et al investigated qSOFA and lactate during a larger review on the enhancement of sepsis identification scores, but did not study this tool in detail. 24 This review aimed to identify and provide high-level evidence as to whether lactate as an additive to qSOFA (LqSOFA) will enhance the rapid stratification of sepsis risk in adult patients with sepsis in various hospital settings, compared with qSOFA alone.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…Kashyap et al investigated qSOFA and lactate during a larger review on the enhancement of sepsis identification scores, but did not study this tool in detail. 24 …”

Section: Introductionmentioning

confidence: 99%

“…Combining biomarkers, such as lactate, with pre-existing clinical scores, such as qSOFA, could enhance swift sepsis recognition,22 23 improving overall patient mortality and morbidity. Kashyap et al investigated qSOFA and lactate during a larger review on the enhancement of sepsis identification scores, but did not study this tool in detail 24…”

Section: Introductionmentioning

confidence: 99%

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Does lactate enhance the prognostic accuracy of the quick Sequential Organ Failure Assessment for adult patients with sepsis? A systematic review

et al. 2022

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ObjectivesTo investigate whether adding lactate to the quick Sequential (sepsis-related) Organ Failure Assessment (qSOFA) improves the prediction of mortality in adult hospital patients, compared with qSOFA alone.DesignSystematic review in accordance with Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies guidelines.Data sourcesEmbase, Medline, PubMed, SCOPUS, Web of Science, CINAHL and Open Grey databases were searched in November 2020.Eligibility criteriaOriginal research studies published after 2016 comparing qSOFA in combination with lactate (LqSOFA) with qSOFA alone in adult patients with sepsis in hospital. The language was restricted to English.Data extraction and synthesisTitle and abstract screening, full-text screening, data extraction and quality assessment (using Quality Assessment of Diagnostic Accuracy Studies-2) were conducted independently by two reviewers. Extracted data were collected into tables and diagnostic test accuracy was compared between the two tests.ResultsWe identified 1621 studies, of which 11 met our inclusion criteria. Overall, there was a low risk of bias across all studies. The area under the receiver operating characteristic (AUROC) curve for qSOFA was improved by the addition of lactate in 9 of the 10 studies reporting it. Sensitivity was increased in three of seven studies that reported it. Specificity was increased in four of seven studies that reported it. Of the six studies set exclusively within the emergency department, five published AUROCs, all of which reported an increase following the addition of lactate. Sensitivity and specificity results varied throughout the included studies. Due to insufficient data and heterogeneity of studies, a meta-analysis was not performed.ConclusionsLqSOFA is an effective tool for identifying mortality risk both in adult inpatients with sepsis and those in the emergency department. LqSOFA increases AUROC over qSOFA alone, particularly within the emergency department. However, further original research is required to provide a stronger base of evidence in lactate measurement timing, as well as prospective trials to strengthen evidence and reduce bias.PROSPERO registration numberCRD42020207648.

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“…While the SOFA score on admission performed well for mortality prediction in sepsis in some studies (5,6), other studies have suggested only intermediate discriminatory accuracy (7,8). The use of SOFA score has also expanded beyond patients with sepsis (9,10) and is used outside of the ICU (6,11).…”

Section: Introductionmentioning

confidence: 99%

SOFA score performs worse than age for predicting mortality in patients with COVID-19

Sherak

Sajjadi

Khimani

et al. 2022

Preprint

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The use of the Sequential Organ Failure Assessment (SOFA) score, originally developed to describe disease morbidity, is commonly used to predict in-hospital mortality. During the COVID-19 pandemic, many protocols for crisis standards of care used the SOFA score to select patients to be deprioritized due to a low likelihood of survival. A prior study found that age outperformed the SOFA score for mortality prediction in patients with COVID-19, but was limited to a small cohort of intensive care unit (ICU) patients and did not address whether their findings were unique to patients with COVID-19. Moreover, it is not known how well these measures perform across races. In this retrospective study, we compare the performance of age and SOFA scores in predicting in-hospital mortality across two cohorts: a cohort of 2,648 consecutive adult patients diagnosed with COVID-19 who were admitted to a large academic health system in the northeastern United States over a 4-month period in 2020 and a cohort of 75,601 patients admitted to one of 335 ICUs in the eICU database between 2014 and 2015. Among the COVID-19 cohort, age (area under receiver-operating characteristic curve (AU-ROC) 0.795, 95% CI 0.762, 0.828) had a significantly better discrimination than SOFA score (AU-ROC 0.679, 95% CI 0.638, 0.721) for mortality prediction. Conversely, age (AU-ROC 0.628 95% CI 0.608, 0.628) underperformed compared to SOFA score (AU-ROC 0.735, 95% CI 0.726, 0.745) in non-COVID-19 ICU patients in the eICU database. There was no difference between Black and White COVID-19 patients in performance of either age or SOFA Score. Our findings bring into question the utility of SOFA score-based resource allocation in COVID-19 crisis standards of care.

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Current Utility of Sequential Organ Failure Assessment Score: A Literature Review and Future Directions

Cited by 18 publications

References 36 publications

Efficacy and safety of adjunctive nebulized colistin sulfate for multidrug-resistant Gram-negative bacteria pneumonia: a retrospective comparative cohort study

Efficacy and safety of adjunctive nebulized colistin sulfate for multidrug-resistant Gram-negative bacteria pneumonia: a retrospective comparative cohort study

Does lactate enhance the prognostic accuracy of the quick Sequential Organ Failure Assessment for adult patients with sepsis? A systematic review

SOFA score performs worse than age for predicting mortality in patients with COVID-19

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