Prospective validation of a near real-time EHR-integrated automated SOFA score calculator

Aakre, Christopher A.; Franco, Pablo Moreno; Ferreyra, Micaela; Kitson, Jaben; Li, Man; Herasevich, Vitaly

doi:10.1016/j.ijmedinf.2017.04.001

Cited by 54 publications

(36 citation statements)

References 20 publications

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“…Serial SOFA scores were only available for patients remaining in the CICU, limiting our assessment of SOFA score changes over time. The variables needed to calculate the SOFA score were not available for all patients, so we imputed the missing variables as normal; in particular, the respiratory SOFA subscore was calculated only for patients with arterial blood gas measurements . This is a significant limitation for interpreting the predictive value of the individual SOFA subscores for mortality, particularly considering the effects of imputing missing data as normal for these subscores.…”

Section: Discussionmentioning

confidence: 99%

“…The variables needed to calculate the SOFA score were not available for all patients, so we imputed the missing variables as normal; in particular, the respiratory SOFA subscore was calculated only for patients with arterial blood gas measurements. 17 This is a significant limitation for interpreting the predictive value of the individual SOFA subscores for mortality, particularly considering the effects of imputing missing data as normal for these subscores. Prior studies have shown that missing variables in prognostic scores for critically ill patients can lead to underestimation of mortality risk.…”

Section: Discussionmentioning

confidence: 99%

“…Demographic and laboratory data and use of invasive and noninvasive ventilation and continuous renal replacement therapy were collected. Daily SOFA scores and individual organ subscores were automatically generated for all patients in the CICU from data in the electronic medical record system, following imputation of missing variables to normal as the default . Acute Physiology and Chronic Health Evaluation (APACHE)‐III scores and APACHE‐IV predicted mortality were automatically generated for all patients in the CICU from data in the electronic medical record system from the first 24 hours of CICU admission .…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Predictive Value of the Sequential Organ Failure Assessment Score for Mortality in a Contemporary Cardiac Intensive Care Unit Population

Jentzer

Bennett

Wiley

et al. 2018

JAHA

133

147

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BackgroundOptimal methods of mortality risk stratification in patients in the cardiac intensive care unit (CICU) remain uncertain. We evaluated the ability of the Sequential Organ Failure Assessment (SOFA) score to predict mortality in a large cohort of unselected patients in the CICU.Methods and ResultsAdult patients admitted to the CICU from January 1, 2007, to December 31, 2015, at a single tertiary care hospital were retrospectively reviewed. SOFA scores were calculated daily, and Acute Physiology and Chronic Health Evaluation (APACHE)‐III and APACHE‐IV scores were calculated on CICU day 1. Discrimination of hospital mortality was assessed using area under the receiver‐operator characteristic curve values. We included 9961 patients, with a mean age of 67.5±15.2 years; all‐cause hospital mortality was 9.0%. Day 1 SOFA score predicted hospital mortality, with an area under the receiver‐operator characteristic curve value of 0.83; area under the receiver‐operator characteristic curve values were similar for the APACHE‐III score, and APACHE‐IV predicted mortality (P>0.05). Mean and maximum SOFA scores over multiple CICU days had greater discrimination for hospital mortality (P<0.01). Patients with an increasing SOFA score from day 1 and day 2 had higher mortality. Patients with day 1 SOFA score <2 were at low risk of mortality. Increasing tertiles of day 1 SOFA score predicted higher long‐term mortality (P<0.001 by log‐rank test).ConclusionsThe day 1 SOFA score has good discrimination for short‐term mortality in unselected patients in the CICU, which is comparable to APACHE‐III and APACHE‐IV. Advantages of the SOFA score over APACHE include simplicity, improved discrimination using serial scores, and prediction of long‐term mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Predictive Value of the Sequential Organ Failure Assessment Score for Mortality in a Contemporary Cardiac Intensive Care Unit Population

Jentzer

Bennett

Wiley

et al. 2018

JAHA

133

147

View full text Add to dashboard Cite

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“…Demographic, clinical, and laboratory data and information relating to therapeutic interventions and procedures were collected. SOFA scores and individual organ subscores were electronically generated using the worst physiologic values from the first 24 hours of CICU admission . Consistent with the established SOFA‐based definition, organ failure was defined as a SOFA organ subscore ≥ 3 for that organ system (Supplemental Table S1).…”

Section: Methodsmentioning

confidence: 99%

“…Organ failure can be quantified using the sequential organ failure assessment (SOFA) score, an illness severity score initially described in patients with sepsis . The SOFA score is calculated based on a four‐point functional assessment for each of six organ systems (central nervous, cardiovascular, respiratory, renal, liver, and coagulation); individual SOFA organ subscores ≥3 reflect failure of that organ system . The number and pattern of failing organ systems are associated with mortality in critically ill patients (especially among patients with sepsis) .…”

Section: Introductionmentioning

confidence: 99%

Early noncardiovascular organ failure and mortality in the cardiac intensive care unit

Jentzer

Wiley

Bennett

et al. 2020

Clinical Cardiology

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Background: Noncardiac organ failure has been associated with worse outcomes among a cardiac intensive care unit (CICU) population.Hypothesis: We hypothesized that early organ failure based on the sequential organ failure assessment (SOFA) score would be associated with mortality in CICU patients.Methods: Adult CICU patients from 2007 to 2015 were reviewed. Organ failure was defined as any SOFA organ subscore ≥3 on the first CICU day. Organ failure was evaluated as a predictor of hospital mortality and postdischarge survival after adjustment for illness severity and comorbidities.Results: We included 10 004 patients with a mean age of 67 ± 15 years (37% female). Admission diagnoses included acute coronary syndrome in 43%, heart failure in 46%, cardiac arrest in 12%, and cardiogenic shock in 11%. Organ failure was present in 31%, including multiorgan failure in 12%. Hospital mortality was higher in patients with organ failure (22% vs 3%, adjusted OR 3.0, 95% CI 2.5-3.7, P < .001).After adjustment, each failing organ system predicted twofold higher odds of hospital mortality (adjusted OR 1.9, 95% CI 1.1-2.1, P < .001). Mortality risk was highest with cardiovascular, coagulation and liver failure. Among hospital survivors, organ failure was associated with higher adjusted postdischarge mortality risk (P < .001); multiorgan failure did not confer added long-term mortality risk.Conclusions: Early noncardiovascular organ failure, especially multiorgan failure, is associated with increased hospital mortality in CICU patients, and this risk continues Abbreviations: APACHE, acute physiology and chronic health evaluation; BMI, body mass index; CCI, Charlson comorbidity index; CI, confidence interval; CICU, cardiac intensive care unit; IABP, intra-aortic balloon pump; LOS, length of stay; OASIS, Oxford Acute Severity of Illness Score; OR, odds ratio; PAC, pulmonary artery catheter; PCI, percutaneous coronary intervention; SOFA, sequential organ failure assessment.

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Association Between Early Treatment With Tocilizumab and Mortality Among Critically Ill Patients With COVID-19

et al. 2021

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IMPORTANCE Therapies that improve survival in critically ill patients with coronavirus disease 2019 (COVID-19) are needed. Tocilizumab, a monoclonal antibody against the interleukin 6 receptor, may counteract the inflammatory cytokine release syndrome in patients with severe COVID-19 illness. OBJECTIVE To test whether tocilizumab decreases mortality in this population. DESIGN, SETTING, AND PARTICIPANTS The data for this study were derived from a multicenter cohort study of 4485 adults with COVID-19 admitted to participating intensive care units (ICUs) at 68 hospitals across the US from March 4 to May 10, 2020. Critically ill adults with COVID-19 were categorized according to whether they received or did not receive tocilizumab in the first 2 days of admission to the ICU. Data were collected retrospectively until June 12, 2020. A Cox regression model with inverse probability weighting was used to adjust for confounding. EXPOSURES Treatment with tocilizumab in the first 2 days of ICU admission. MAIN OUTCOMES AND MEASURES Time to death, compared via hazard ratios (HRs), and 30-day mortality, compared via risk differences. RESULTS Among the 3924 patients included in the analysis (2464 male [62.8%]; median age, 62 [interquartile range {IQR}, 52-71] years), 433 (11.0%) received tocilizumab in the first 2 days of ICU admission. Patients treated with tocilizumab were younger (median age, 58 [IQR, 48-65] vs 63 [IQR, 52-72] years) and had a higher prevalence of hypoxemia on ICU admission (205 of 433 [47.3%] vs 1322 of 3491 [37.9%] with mechanical ventilation and a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen of <200 mm Hg) than patients not treated with tocilizumab. After applying inverse probability weighting, baseline and severity-of-illness characteristics were well balanced between groups. A total of 1544 patients (39.3%) died, including 125 (28.9%) treated with tocilizumab and 1419 (40.6%) not treated with tocilizumab. In the primary analysis, during a median follow-up of 27 (IQR, 14-37) days, patients treated with tocilizumab had a lower risk of death compared with those not treated with tocilizumab (HR, 0.71; 95% CI, 0.56-0.92). The estimated 30-day mortality was 27.5% (95% CI, 21.2%-33.8%) in the tocilizumab-treated patients and 37.1% (95% CI, 35.5%-38.7%) in the non-tocilizumab-treated patients (risk difference, 9.6%; 95% CI, 3.1%-16.0%). CONCLUSIONS AND RELEVANCE Among critically ill patients with COVID-19 in this cohort study, the risk of in-hospital mortality in this study was lower in patients treated with tocilizumab in the first 2 days of ICU admission compared with patients whose treatment did not include early use of tocilizumab. However, the findings may be susceptible to unmeasured confounding, and further research from randomized clinical trials is needed.

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Prospective validation of a near real-time EHR-integrated automated SOFA score calculator

Cited by 54 publications

References 20 publications

Predictive Value of the Sequential Organ Failure Assessment Score for Mortality in a Contemporary Cardiac Intensive Care Unit Population

Predictive Value of the Sequential Organ Failure Assessment Score for Mortality in a Contemporary Cardiac Intensive Care Unit Population

Early noncardiovascular organ failure and mortality in the cardiac intensive care unit

Association Between Early Treatment With Tocilizumab and Mortality Among Critically Ill Patients With COVID-19

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