Racial disparities in the SOFA score among patients hospitalized with COVID-19

Abstract

Background Sequential Organ Failure Assessment (SOFA) score predicts probability of in-hospital mortality. Many crisis standards of care suggest the use of SOFA scores to allocate medical resources during the COVID-19 pandemic. Research question Are SOFA scores elevated among Non-Hispanic Black and Hispanic patients hospitalized with COVID-19, compared to Non-Hispanic White patients? Study design and methods Retrospective cohort study conducted in Yale New Haven Health System, including 5 hospitals with total of 2681 beds. Study population drawn from consecutive patients aged ≥18 admitted with COVID-19 from March 29th to August 1st, 2020. Patients excluded from the analysis if not their first admission with COVID-19, if they did not have SOFA score recorded within 24 hours of admission, if race and ethnicity data were not Non-Hispanic Black, Non-Hispanic White, or Hispanic, or if they had other missing data. The primary outcome was SOFA score, with peak score within 24 hours of admission dichotomized as <6 or ≥6. Results Of 2982 patients admitted with COVID-19, 2320 met inclusion criteria and were analyzed, of whom 1058 (45.6%) were Non-Hispanic White, 645 (27.8%) were Hispanic, and 617 (26.6%) were Non-Hispanic Black. Median age was 65.0 and 1226 (52.8%) were female. In univariate logistic screen and in full multivariate model, Non-Hispanic Black patients but not Hispanic patients had greater odds of an elevated SOFA score ≥6 when compared to Non-Hispanic White patients (OR 1.49, 95%CI 1.11–1.99). Interpretation Given current unequal patterns in social determinants of health, US crisis standards of care utilizing the SOFA score to allocate medical resources would be more likely to deny these resources to Non-Hispanic Black patients.

Development and Internal Validation of a New Prognostic Model Powered to Predict 28-Day All-Cause Mortality in ICU COVID-19 Patients—The COVID-SOFA Score

“…Moreover, increased heterogeneity was observed in the reported SOFA score values between survivors and non-survivors [ 26 , 27 , 28 , 29 ]. For patients requiring NIV or HFOT, the median SOFA scores were 4 (3–5) and 3 (2–3) points, and this was similar for other study populations in which the mean SOFA score values ranged between 2.4 and 4.8 [ 22 , 29 ] points. Lastly, the presence of bacterial co-infection can modify the SOFA score values, as bacterial and viral sepsis have different features [ 2 ] and the SOFA score was mainly studied in bacterial sepsis.…”

“…Regarding hematological changes induced by SARS-CoV-2, these were similar with previously reported data, with lymphopenia, neutrophilia and higher D-dimer values being associated with poor outcome [ 19 , 20 ]. The SOFA score values in COVID-19 patients admitted to ICU have important variations between studies [ 19 ], depending on: (i) the selected patients, (ii) the moment of measurement (e.g., ICU admission, before endotracheal intubation, repeated measurements), and (iii) missing data and how points were assigned [ 21 , 22 , 23 , 24 , 25 ]. In our study, the median SOFA score at ICU admission was significantly different depending on the level of respiratory support required.…”

“…These data led to ethical concerns when using the SOFA score to decide to whom a ventilator would be allocated in a crisis management protocol [ 5 , 6 ]. Tolchin et al observed that in triage protocols that use the SOFA score, Non-Hispanic Black patients were more likely to have higher SOFA scores and restricted access to ICU beds or ventilators [ 22 ]. The goal should be to create a better predictive model with an improved prediction error rate that will further reduce biased decisions regarding the care provided to critically ill COVID-19 patients [ 5 ].…”

Association between Mortality and Sequential Organ Failure Assessment Score during a Short Stay in the Intensive Care Unit after Non-Cardiac Surgery

“…The clinical relevance should be carefully considered when interpreting the results from artificial intelligence in medicine. According to our SHAP summary plot, advanced age had a definite positive impact on increasing SOFA score, which has been suggested as a risk factor in other clinical settings as well [ 30 , 31 ]. The total operation time is also a well-known risk factor for postoperative outcomes but has rarely been associated with the SOFA score.…”

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

“…Although the SOFA score was originally created for ICU patients (1) 23). This suggests that Black patients with COVID-19 may be more likely than White patients to be assigned higher SOFA scores but will have similar mortality rates at those higher SOFA scores.…”