The prognostic value of the SOFA score in patients with COVID-19: a retrospective, observational study

Abstract

Background Patients with Coronavirus disease 2019 (COVID-19) have a high mortality rate, and thus, it is particularly important to predict the severity and prognosis of COVID-19. The Sequential Organ Failure Assessment (SOFA) score has been used to predict the clinical outcomes of patients with multiple organ failure requiring intensive care. Therefore, we retrospectively analyzed the clinical characteristics, risk factors, and relationship between the SOFA score and the prognosis of COVID-19 patients. Methods Clinical variables were compared between patients with mild and severe COVID-19. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for severe COVID-19. The Cox proportional hazards model was used to analyze risk factors for hospital-related death. Survival analysis was performed by the Kaplan-Meier method, and survival differences were assessed by the log-rank test. Receiver operating characteristic (ROC) curves of the SOFA score in different situations were drawn, and the area under the ROC curve was calculated. Results The median SOFA score of all patients was 2 (IQR, 1–3). Patients with severe COVID-19 exhibited a significantly higher SOFA score than patients with mild COVID-19 [3 (IQR, 2–4) vs 1 (IQR, 0–1); P < 0.001]. The SOFA score increased the risk of severe COVID-19, with an odds ratio of 5.851 (95% CI: 3.044–11.245; P < 0.001). The area under the ROC curve (AUC) was used to evaluate the diagnostic accuracy of the SOFA score in predicting severe COVID-19 [cutoff value = 2; AUC = 0.908 (95% CI: 0.857–0.960); sensitivity: 85.20%; specificity: 80.40%] and the risk of death in COVID-19 patients [cutoff value = 5; AUC = 0.995 (95% CI: 0.985-1.000); sensitivity: 100.00%; specificity: 95.40%]. Regarding the 60-day mortality rates of patients in the two groups classified by the optimal cutoff value of the SOFA score (5), patients in the high SOFA score group (SOFA score ≥ 5) had a significantly greater risk of death than those in the low SOFA score group (SOFA score < 5). Conclusion The SOFA score could be used to evaluate the severity and 60-day mortality of COVID-19. The SOFA score may be an independent risk factor for in-hospital death.

Factors associated with mortality among moderate and severe patients with COVID-19 in India: a secondary analysis of a randomised controlled trial

“…Studies have shown that the SOFA score could be used to evaluate severity and 60-day mortality of COVID-19 with the optimal cut-off score of 5. 39 The limitations of this study include the variability of treatment provided in the multiple centres. The participants of this study may not comprise a true observational cohort, as this was a post hoc analysis of randomised controlled trial data and extrapolation to the general population must be carefully qualified.…”

“…Studies have shown that the SOFA score could be used to evaluate severity and 60-day mortality of COVID-19 with the optimal cut-off score of 5. 39 …”

Predicting COVID-19 progression from diagnosis to recovery or death linking primary care and hospital records in Castilla y León (Spain)

“…To our knowledge, most of the contributions on predictive models for COVID-19 progression are hampered by either a somewhat limited access to data (typically, they are exclusively based on data from hospitalised or critical patients) or by the simplistic nature of the predictive models considered (which, of course, is often related to the limited access of useful data). As an example, [ 4 ] considers a wide collection of predictors but it is based on a very small sample of hospitalised patients. This reference uses Cox regression models, but with death as the only event of interest.…”

Characteristics And Outcomes of Sepsis Patients With And Without COVID-19

“…We observed a slightly better than expected in-hospital mortality and hypothesize that increased survival in our patients might be due to the established multidisciplinary and multisectoral pathway. Severity of COVID-19 infection and a higher SOFA seem to be strongly associated [10]. In this context, it should be noted that platelet count and parameter of liver injury (bilirubin) and kidney disease (serum creatinine) are part of the SOFA score, which furthermore comprises ventilation (oxygenation index) and circulation-support parameters (use of vasoactive medication), as well as Glasgow Coma Score value which is decreased in critically ill patients due to sedation.…”

“…Increased disease severity in COVID-19 was found to be associated with demographic factors (higher age, male gender) and comorbidities such as, obesity, diabetes, hypertension and coronary heart disease [6]. The development of acute kidney injury (AKI) and increased SOFA score on admission are considered negative prognostic factors for clinical outcomes [7] [8,9] [10]. Moreover, increased white blood cell count, elevated level of C-reactive protein (CRP), Procalcitonin (PCT), Interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), lactate dehydrogenase (LDH) and signs of hypercoagulopathy (low platelet count and increased D-dimers, Fibrinogen and Prothrombin Time) were associated with higher severity and increased mortality of COVID-19 [11][12][13][14].…”