Sequential organ failure assessment score predicts mortality after coronary artery bypass grafting

Abstract

BackgroundMortality after coronary artery bypass grafting (CABG) is generally associated with underlying disease and surgical factors overlooked in preoperative prognostic models. Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE II) scores are widely used in intensive care units for outcome prediction. This study investigated the accuracy of these models in predicting mortality.MethodsBetween January 2010 and April 2013, 483 patients who underwent isolated CABG were enrolled. The clinical characteristics, outcomes, and prognostic model scores of the patients were collected. Discrimination was assessed using the area under the curve approach.ResultsBoth SOFA and APACHE II scores were effective for predicting in-hospital mortality. Among the organ systems examined in the SOFA, the cardiac and renal systems were the strongest predictors of CABG mortality. Multivariate analysis identified only the SOFA score as being an independent risk factor for mortality.ConclusionIn summary, the SOFA score can be used to accurately identify mortality after isolated CABG.

Vasoactive-inotropic score and the prediction of morbidity and mortality after cardiac surgery

“…30,31 We found that VIS max measured on the 1st postoperative day predicted mortality up to 1 yr, while most earlier studies reported only in-ICU, in-hospital, and 30-day mortality. 1,2,8,32,33 The findings of the current study showed relatively low mortality in the lowest three VIS max groups for up to 1 yr. 10,34 Higher vasoactive and inotropic medication doses were associated with short-term and intermediate-term mortality after cardiac surgery (Fig. 4).…”

“…Traditional ICU scoring systems were initially developed and validated for general ICU patients, 2 and then studied in cardiac surgery patients. 1,3,6 Those scoring systems measure multiple organ dysfunction in critically ill patients, and only roughly quantitate pharmacological cardiovascular system support. In the early postoperative period after cardiac surgery, patients with a poor prognosis often do not manifest dysfunction of other organs to the same extent as they have cardiac dysfunction.…”

“…Fourth, our composite outcome included mortality and adverse events, while some other studies evaluating scoring systems have focused on shortterm mortality. 1,2,8,32,33 One limitation was that this was a single-centre study; VIS max group adjustment may be required in other cardiac surgical units, which may differ regarding vasoactive and inotropic medication treatment regimens and availability of mechanical cardiovascular support devices. Second, predictive models have limitations related to prediction of infrequent events, and earlier studies show low mortality and morbidity in cardiac surgery.…”

“…However, they were not developed for postoperative cardiac surgery patients, and thus do not consider surgical success or patients' responses to surgery and cardiopulmonary bypass. 1 In the ICU, mortality and morbidity risk are often estimated using scoring systems such as the Simplified Acute Physiological Score (SAPS II/III), 2,3 Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE II). 1,4,5 Although cardiac surgery patients were excluded during their development, these instruments have been studied for risk assessment after cardiac surgery.…”

“…1 In the ICU, mortality and morbidity risk are often estimated using scoring systems such as the Simplified Acute Physiological Score (SAPS II/III), 2,3 Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE II). 1,4,5 Although cardiac surgery patients were excluded during their development, these instruments have been studied for risk assessment after cardiac surgery. 1e3, 6 Specific heart surgery risk scoresdsuch as the EuroScore II, Society of Thoracic Surgeons (STS) risk score, and Parsonnet score dwere developed to estimate the risk of cardiac surgery, mainly using preoperative health data.…”