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Excerpt
Introduction: Using the sequential organ failure assessment(SOFA)score, we analyzed the relation between organ dysfunction and outcome in critically ill patients. Methods: Data from consecutive adult patients staying longer than 24 hours in a medico-surgical intensive care unit (ICU) were collected prospectively. The SOFA score was calculated every two days. Outcome and length of stay (LOS) were also analyzed. Results: During a 4 month-period, 352 patients were enrolled. Of all SOFA-derived parameters, the maximal SOFA score obtained during the ICU stay was the strongest predictor of survival [OR 0.63 CI(0.57-0.69)], followed by the mean SOFA over time [OR 0.33 CI(0.25 - 0.42)], initial SOFA [OR 0.69 CI(0.63 - 0.76)] and total SOFA (sum of all scores during ICU stay) [OR 0.95 CI(0.94 - 0.97)]. Delta SOFA (difference between consecutive measures) was a better prognostic index over the first 48h [0.66 CI(0.56 - 0.77)] than over the next 48h [0.80 CI(0.68- 0.96). Trends in SOFA score during the first 48h indicated a mortality rate ≥50% when the SOFA score increased, between 27 and 35% when it did not change and ≤27% when it decreased. These values were independent of the initial SOFA score. Conclusion: In addition to the maximal and the initial SOFA score, the mean SOFA over the ICU stay and the changes in SOFA over the first 48h, were highly reliable predictors of outcome. Independent of the initial value, an increase in SOFA score during the first 48 hours predicts a mortality rate of at least 50%.
