Sequential Organ Failure Assessment Component Score Prediction of In-hospital Mortality From Sepsis

Gupta, Tushar; Puskarich, Michael A.; DeVos, Elizabeth; Javed, Adnan; Smotherman, Carmen; Sterling, Sarah A.; Wang, Henry E.; Moore, Frederick A.; Jones, Alan E.; Guirgis, Faheem W.

doi:10.1177/0885066618795400

Cited by 31 publications

(33 citation statements)

References 22 publications

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“…Finally, it is probable that the underlying disease processes producing liver and coagulation failure were themselves associated with adverse outcomes. Sepsis was approximately twice as prevalent in patients with liver and coagulation failure, and the liver and coagulation SOFA subscores were most strongly predictive of mortality in a recent study of patients with sepsis …”

Section: Discussionmentioning

confidence: 96%

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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Section: Discussionmentioning

confidence: 96%

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

Jentzer

Wiley

Bennett

et al. 2020

Clinical Cardiology

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“…24 Furthermore, the SOFA score requires numerous calculations and invasive tests that may dissuade clinician use. 30 The qSOFA score was designed as a wardbased sepsis screening tool rather than as an ICU MPM. 1 When applied to adults with sepsis at ICU admission, the qSOFA was not an effective ICU MPM, and hence, its use may be limited outside its intended scope.…”

Section: Assessing Current Mpmsmentioning

confidence: 99%

The 4-Hour Cairns Sepsis Model: A novel approach to predicting sepsis mortality at intensive care unit admission

Hargovan¹,

Gunnarsson²,

Carter³

et al. 2021

Australian Critical Care

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Background: Sepsis commonly causes intensive care unit (ICU) mortality, yet early identification of adults with sepsis at risk of dying in the ICU remains a challenge. Objective: The aim of the study was to derive a mortality prediction model (MPM) to assist ICU clinicians and researchers as a clinical decision support tool for adults with sepsis within 4 h of ICU admission. Methods: A cohort study was performed using 500 consecutive admissions between 2014 and 2018 to an Australian tertiary ICU, who were aged !18 years and had sepsis. A total of 106 independent variables were assessed against ICU episode-of-care mortality. Multivariable backward stepwise logistic regression derived an MPM, which was assessed on discrimination, calibration, fit, sensitivity, specificity, and predictive values and bootstrapped. Results: The average cohort age was 58 years, the Acute Physiology and Chronic Health Evaluation III-j severity score was 72, and the case fatality rate was 12%. The 4-Hour Cairns Sepsis Model (CSM-4) consists of age, history of renal disease, number of vasopressors, Glasgow Coma Scale, lactate, bicarbonate, aspartate aminotransferase, lactate dehydrogenase, albumin, and magnesium with an area under the receiver operating characteristic curve of 0.90 (95% confidence interval ¼ 0.84e0.95, p < 0.00001), a Nagelkerke R 2 of 0.51, specificity of 0.94, a negative predictive value of 0.98, and almost identical odds ratios during bootstrapping. The CSM-4 outperformed existing MPMs tested on our data set. The CSM-4 also performed similar to existing MPMs in their derivation papers whilst using fewer, routinely collected, and inexpensive variables. Conclusions: The CSM-4 is a newly derived MPM for adults with sepsis at ICU admission. It displays excellent discrimination, calibration, fit, specificity, negative predictive value, and bootstrapping values whilst being easy to use and inexpensive. External validation is required.

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“…It re ects the number of dysfunctional organs as well as the degree of damage [17,18] .Therefore the SOFA score is commonly used to predict ICU mortality in critically ill patients, especially those with sepsis [19,20] . Gupta, T et al demonstrated that elevated hepatic SOFA scores were most predictive of in-hospital death [21] . In addition, serum T-BIL level lactate level, lactate clearance rate, increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and decreased C3 and C4 were all independent risk factors for the prognosis of liver injury [22][23][24][25] .…”

Section: Introductionmentioning

confidence: 99%

Total SOFA and SOFA Kidney are Associated with Short Term and Long term Outcoming of Sepsis-Associated Liver Injury

Liang²,

et al. 2021

Preprint

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Background: Liver injury is considered as a common complication of sepsis. However, there are still few studies on short-term and long-term prognostic factors of sepsis-associated liver injury (SALI). The objective of our study is to conduct a large sample data cohort study to explore the risk factors for short-term and long-term prognosis of SALI.Methods: Data from a public, US-based, critical-care database (Medical Information Mart for Intensive Care-III [MIMIC-III]) was used. Septic patients who met the definition of acute liver injury were enrolled. Variables extracted from MIMIC-III were used to evaluate patient demographics, clinical characteristics on Day 1 of intensive care unit admission, and clinical outcomes. The Logistic regression models were used to calculate risk ratio (RR) and 95% confidence intervals (CIs) after adjusting for potential factors. Results: Among the 14687 participants in our study, there were 3140 (21.38%) with SALI. SALI was significantly positively associated with ICU mortality (RR, 1.54; 95% CI, 1.32, 1.79), 28-day mortality (RR, 1.27; 95% CI, 1.11, 1.45) and 1-year mortality (RR, 1.19; 95% CI, 1.06, 1.34) after adjusting confounding factors. Stratified by SOFA, there was a positive association between SALI and ICU mortality (RR, 2.15; 95% CI, 1.64, 2.80), 28-day mortality (RR, 1.60; 95% CI, 1.28, 1.99), 1-year mortality (RR, 1.24; 95% CI, 1.04, 1.48) after adjusting confounding factors among people with sofa score ≤ 5. Similar results were also obtained between SALI and ICU mortality (RR,1.40; 95% CI, 1.17, 1.67), 28-day mortality (RR, 1.17; 95% CI, 0.99, 1.38), 1-year mortality (RR, 1.19; 95% CI, 1.02, 1.38) after adjusting confounding factors among people with sofa score> 5. Compared with SOFA renal> 1, SALI had a stronger positive correlation with ICU mortality (RR, 1.36; 95% CI, 1.01, 1.84), 28-day mortality (RR, 1.19; 95% CI, 0.91, 1.56), 1-year mortality (RR, 1.11; 95% CI, 0.88, 1.41) after adjusted confounding factors among people with SOFA renal ≤ 1.Conclusions: SALI was an independent risk factor for ICU mortality, 28-day mortality and 1-year mortality. And there is a close association between liver and kidney in sepsis, but the mechanism is still unclear and requires further study.

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Sequential Organ Failure Assessment Component Score Prediction of In-hospital Mortality From Sepsis

Cited by 31 publications

References 22 publications

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

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

The 4-Hour Cairns Sepsis Model: A novel approach to predicting sepsis mortality at intensive care unit admission

Total SOFA and SOFA Kidney are Associated with Short Term and Long term Outcoming of Sepsis-Associated Liver Injury

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