Initial Sequential Organ Failure Assessment score versus Simplified Acute Physiology score to analyze multiple organ dysfunction in infectious diseases in Intensive Care Unit

Abstract

Aims:To investigate initial Sequential Organ Failure Assessment (SOFA) score of patients in Intensive Care Unit (ICU), who were diagnosed with infectious disease, as an indicator of multiple organ dysfunction and to examine if initial SOFA score is a better mortality predictor compared to Simplified Acute Physiology Score (SAPS).Materials and Methods:Hospital-based study done in medical ICU, from June to September 2014 with a sample size of 48. Patients aged 18 years and above, diagnosed with infectious disease were included. Patients with history of chronic illness (renal/hepatic/pulmonary/ cardiovascular), diabetes, hypertension, chronic obstructive pulmonary disease, heart disease, those on immunosuppressive therapy/chemoradiotherapy for malignancy and patients in immunocompromised state were excluded. Blood investigations were obtained. Six organ dysfunctions were assessed using initial SOFA score and graded from 0 to 4. SAPS was calculated as the sum of points assigned to each of the 17 variables (12 physiological, age, type of admission, and three underlying diseases). The outcome measure was survival status at ICU discharge.Results:We categorized infectious diseases into dengue fever, leptospirosis, malaria, respiratory tract infections, and others which included undiagnosed febrile illness, meningitis, urinary tract infection and gastroenteritis. Initial SOFA score was both sensitive and specific; SAPS lacked sensitivity. We found no significant association between age and survival status. Both SAPS and initial SOFA score were found to be statistically significant as mortality predictors. There is significant association of initial SOFA score in analyzing organ dysfunction in infectious diseases (P < 0.001). SAPS showed no statistical significance. There was statistically significant (P = 0.015) percentage of nonsurvivors with moderate and severe dysfunction, based on SOFA score. Nonsurvivors had higher SAPS but was not statistically significant (P = 0.094).Conclusions:Initial SOFA score is a superior mortality predictor. It easily measures degree of organ dysfunction in infectious diseases and complements other scoring systems.

The predictive power of SAPS-3 and SOFA scores and their relations with patient outcomes in the Surgical Intensive Care Unit

“…AUC with SOFA score was found as 0.63,1 whereas it was found as 0.754 with SAPS-3. It is parallel to other studies that have found AUC 0.748 versus 0.810 (SOFA score versus SAPS-3 score) (16,17). Besides that, according to our findings, in this study SAPS-3 and SOFA are closely related to LOS in the ICU for more than 3 days.…”

“…Originally, SOFA score is computed 1 day after ICU admission and every 2 days subsequently. The highest scores are claimed to be most predictive of mortality (16). In our study, SOFA and SAPS-3 scores were calculated using data derived in the ICU admission day 0 retrospectively and the average scores were significantly higher in the non-surviving group.…”

“…Some studies have compared the SOFA score with another PSS-Acute Physiology and Chronic Health Disease Classification System (APACHE) score-as a mortality prediction model to predict hospital mortality and concluded that the combination of both scores enhances prognostic value (19,20). In another study, initial SOFA score has been found comparable to APACHE 3 in the ICU mortality prediction (16).…”

Predictive value of the sequential organ failure assessment (SOFA) score for prognosis in patients with severe acute ischemic stroke: a retrospective study

“…The SOFA score was designed to develop an objective tool to quantify single and multiple organ failure of patients. 17 The function of this model in critically ill patients has been validated by cohort studies. 33,34 The SOFA score has a variety of characteristics that make it applicable in the emergency department and it can be easily performed and calculated at the patients' bedside.…”

“…Each organ system was graded from 0 to 4 according to the extent of failure, and the total score ranged from 0 to 24. 17 Each organ system was scored on the basis of its worst case of the particular day, and the total score was calculated by summing the scores for each of the six organ systems. This study assessed the total SOFA scores on days 1, 4, 7, 10, and 14 after admission, the total maximum SOFA score, and the change in SOFA (ΔSOFA) score.…”