Sequential Organ Failure Assessment (SOFA) score for predicting mortality in patients with sepsis in Vietnamese intensive care units: A multicentre, cross-sectional study

Abstract

ObjectivesTo compare the accuracy of the SOFA and APACHE II scores in predicting short-term mortality among ICU patients with sepsis in an LMIC.DesignA multicentre, cross-sectional study.SettingA total of 15 adult ICUs from 14 hospitals, of which 5 are central hospitals, and 9 are provincial, district, or private hospitals, throughout Vietnam.ParticipantsWe included all patients aged ≥18 years who were admitted to ICUs for sepsis and who were still in ICUs from 00:00 hour to 23:59 hour of the study days (i.e., 9th January, 3rd April, 3rd July, and 9th October of 2019).Main outcome measuresShort-term mortality was the main outcome, including hospital and ICU mortality.ResultsOf 252 patients, 40.1% died in hospitals, and 33.3% died in ICUs. SOFA (cut-off value ≥7.5; AUROC: 0.688 [95% CI: 0.618-0.758]; p<0.001) and APACHE II score (cut-off value ≥20.5; AUROC: 0.689 [95% CI: 0.622-0.756]; p<0.001) both had a poor discriminatory ability for predicting hospital mortality. However, the discriminatory ability for predicting ICU mortality of SOFA (cut-off value ≥9.5; AUROC: 0.713 [95% CI: 0.643-0.783]; p<0.001) was better and greater than that of APACHE II score (cut-off value ≥18.5; AUROC: 0.672 [95% CI: 0.603-0.742]; p<0.001). A SOFA score ≥8 (OR: 2.717; 95% CI: 1.371-5.382) and an APACHE II score ≥21 (OR: 2.668; 95% CI: 1.338-5.321) were independently associated with an increased risk of hospital mortality. Additionally, a SOFA score ≥10 (OR: 2.194; 95% CI: 1.017-4.735) was an independent predictor of ICU mortality, in contrast to an APACHE II score ≥19, for which this role did not.ConclusionsBoth SOFA and APACHE II scores were worthwhile in predicting hospital and ICU mortality among ICU patients with sepsis. However, due to good discrimination for predicting ICU mortality, the SOFA was preferable to the APACHE II score in predicting short-term mortality.Strengths and limitations of this studyAn advantage of the present study was data from multicentre, which had little missing data.Due to the absence of a national registry of intensive care units (ICUs) to allow systematic recruitment of units, we used a snowball method to identify suitable units, which might have led to the selection of centres with a greater interest in sepsis management.Due to the study’s real-world nature, we did not make a protocol for microbiological investigations. Moreover, we mainly evaluated resources utilized in ICUs; therefore, the data detailing the point-of-care testing and life-sustaining treatments were not available.To improve the feasibility of conducting the study in busy ICUs, we opted not to collect data on antibiotic resistance and appropriateness.The sample size was relatively small, which might have led to overfitting in the multivariable prediction model.

Predictive validity of the simplified Radiographic Assessment of Lung Edema score for the mortality in critically ill COVID-19 patients with the B.1.617.2 (Delta) variant in Vietnam: a single-centre, cross-sectional study

“…The variation observed may stem from differences in the patients, pathogens, and clinical ability to care for critically ill patients between low- to middle-income and high-income country settings. (34–37) Additionally, the study centre almost only admitted critically ill patients with COVID-19 (92.4%, 85/92; S1 Table in S1 File) who encountered difficulties accessing treatment at lower-level hospitals, with a low rate of intubation (16.7%, 16/96; S1 Table in S1 File) and mechanical ventilation (14.0%, 14/100; S1 Table in S1 File) during transportation. Transferring critically ill patients with COVID-19 from a local to a central hospital may result in the worsening of their critical condition.…”

“…Several predictive models have been suggested, but none stands out as significantly superior or precisely predicts the deterioration or mortality in critically ill patients with COVID-19. (34, 35, 52–56) Although the APACHE IV score is the most up-to-date version, some centres still use older versions, including the APACHE II score. The present study showed that the APACHE II score had poor discrimination in predicting hospital mortality in critically ill COVID-19 patients (S6 Table in S1 File), aligned with the finding of an earlier published Belgian retrospective study, which also reported a poor discriminatory ability in predicting hospital mortality using the APACHE II score (AUROC: 0.633).…”

Navigating the Complexity of Scoring Systems in Sepsis Management: A Comprehensive Review

“…Some scholars contend that its efficacy in predicting mortality at 24 hours and across diverse types of infections may be limited. Furthermore, the score's predictive value may exhibit variability when applied in different economic settings, distinguishing between high-income and low- to middle-income countries [ 10 ]. Despite these acknowledged limitations, the SOFA score retains its merit as a valuable instrument for assessing the severity of sepsis-related organ dysfunction, boasting high accuracy in delineating the course of organ dysfunction in septic patients [ 7 ].…”