Mortality prediction by SOFA score in ICU-patients after cardiac surgery; comparison with traditional prognostic–models

Abstract

Background: There are many prognostic models and scoring systems in use to predict mortality in ICU patients. The only general ICU scoring system developed and validated for patients after cardiac surgery is the APACHE-IV model. This is, however, a labor-intensive scoring system requiring a lot of data and could therefore be prone to error. The SOFA score on the other hand is a simpler system, has been widely used in ICUs and could be a good alternative. The goal of the study was to compare the SOFA score with the APACHE-IV and other ICU prediction models. Methods: We investigated, in a large cohort of cardiac surgery patients admitted to Dutch ICUs, how well the SOFA score from the first 24 h after admission, predict hospital and ICU mortality in comparison with other recalibrated general ICU scoring systems. Measures of discrimination, accuracy, and calibration (area under the receiver operating characteristic curve (AUC), Brier score, R 2 , and Ĉ-statistic) were calculated using bootstrapping. The cohort consisted of 36,632 Patients from the Dutch National Intensive Care Evaluation (NICE) registry having had a cardiac surgery procedure for which ICU admission was necessary between January 1st, 2006 and June 31st, 2018. Results: Discrimination of the SOFA-, APACHE-IV-, APACHE-II-, SAPS-II-, MPM 24-II-models to predict hospital mortality was good with an AUC of respectively: 0.809, 0.851, 0.830, 0.850, 0.801. Discrimination of the SOFA-, APACHE-IV-, APACHE-II-, SAPS-II-, MPM 24-II-models to predict ICU mortality was slightly better with AUCs of respectively: 0.809, 0.906, 0.892, 0.919, 0.862. Calibration of the models was generally poor. Conclusion: Although the SOFA score had a good discriminatory power for hospital-and ICU mortality the discriminatory power of the APACHE-IV and SAPS-II was better. The SOFA score should not be preferred as mortality prediction model above traditional prognostic ICU-models.

Association between glucose variability and postoperative delirium in acute aortic dissection patients: an observational study

“…The more serious the illness is, the higher the score is. Studies have shown that the severity of the disease is closely related to the risk of delirium [ 17 , 18 ].…”

Predictive performance of SOFA and qSOFA for in-hospital mortality in severe novel coronavirus disease

“…A higher score infers aggravating conditions in the patients. Although SOFA was not initially designed to predict mortality, several studies revealed that the SOFA score could predict morbidity and mortality and this specific application has been validated in severely ill patients [ [9] , [10] , [11] , [12] , [13] ].Therefore, it is of interest to determine whether the SOFA score could predict mortality in the COVID-19 population.…”

Association of glucose variability with postoperative delirium in acute aortic dissection patients: an observational study

“…The more serious the illness is, the higher the score is. Studies have shown that the severity of the disease is closely related to the risk of delirium 18,19 .…”