The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study

Moreno, Rui P.; Vincent, Jean‐Louis; Matos, Ricardo; Mendonça, Arnaldo de; Cantraine, Francis; Thijs, L. G.; Takala, Jukka; Sprung, Charles L.; Antonelli, Massimo; Bruining, H. A.; Willatts, Sheila M.

doi:10.1007/s001340050931

Cited by 782 publications

(650 citation statements)

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“…Moreno et al on behalf of the working group on sepsis related problems of the ESICM reported on the discriminatory ability of the maximum and admission SOFA scores to predict ICU mortality. 11 They found the AuROC to be 0.85 for the maximum SOFA score and 0.77 for the admission SOFA score compared with 0.69 and 0.67, respectively, in our study. Although these studies were similar in size and both excluded routine postoperative patients staying less than 48 hr, several important differences exist.…”

Section: Association With and Ability To Discriminate Outcomesupporting

confidence: 49%

“…The SOFA score has been validated against mortality in multiple subsequent studies. [9][10][11][12] The other significant difference is in the timing in calculating the score in each system. SOFA is calculated based on the most abnormal value in a 24-hr period, whereas the MOD score is calculated using physiologic values measured at the same point in time every day (first morning values) to avoid capturing momentary physiologic changes unrelated to changes in the patient's underlying physiologic status.…”

Section: Résultats : Concernant La Mortalité à L'usi Et à L'hôpital mentioning

confidence: 99%

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Neuroanesthesia and Intensive Care Limited ability of SOFA and MOD scores to discriminate outcome: a prospective evaluation in 1,436 patients

Zygun

Laupland

Fick³

et al. 2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : The multiple organ dysfunction (MOD) score and sequential organ failure assessment (SOFA) score are measures of organ dysfunction and have been validated based on the association of these scores with mortality. We sought to compare the performance of the SOFA and MOD scores in a large cohort of consecutive multisystem intensive care unit (ICU) patients.M Me et th ho od ds s: : Prospective automated daily measurements of MOD and SOFA scores were performed in 1,436 patients admitted to a multisystem ICU in the Calgary Health Region over a one-year period. Logistic regression modeling techniques were used to describe the association of SOFA and MODS with mortality. Receiver operator characteristic (ROC) curves were used to assess the model's discriminatory ability.R Re es su ul lt ts s: : For ICU and hospital mortality, there was very little practical difference between the SOFA and MOD scores in their ability to discriminate outcome as determined by the area under the ROC. However, compared to previous literature, the discriminatory ability of both scores in this population was weak. As well, the calibration of the models was poor for both scores. The SOFA cardiovascular component score performed better than the MOD cardiovascular component score in the discrimination of both ICU and hospital mortality.C Co on nc cl lu us si io on ns s: : SOFA and MOD scores had only a modest ability to discriminate between survivors and non-survivors. These results question the appropriateness of using organ dysfunction scores as a 'surrogate' for mortality in clinical trials and suggest further work is necessary to better understand the temporal relationship and course of organ failure with mortality. Objectif : Le score de défaillance multiviscérale (DMV) et

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Section: Association With and Ability To Discriminate Outcomesupporting

confidence: 49%

Section: Résultats : Concernant La Mortalité à L'usi Et à L'hôpital mentioning

confidence: 99%

Neuroanesthesia and Intensive Care Limited ability of SOFA and MOD scores to discriminate outcome: a prospective evaluation in 1,436 patients

Zygun

Laupland

Fick³

et al. 2005

Can J Anesth/J Can Anesth

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“…This goal will also have lesser impact on immune response to infection, thus reducing the potential for sepsis, multi-organ dysfunction and failure, and thus death [36,[71][72][73][74].…”

Section: Discussionmentioning

confidence: 99%

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

Chase

Compte

Suhaimi

et al. 2011

Computer Methods and Programs in Biomedicine

119

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Tight glycemic control (TGC) has emerged as a major research focus in critical care due to its potential to simultaneously reduce both mortality and costs. However, repeating initial successful TGC trials that reduced mortality and other outcomes has proven difficult with more failures than successes. Hence, there has been growing debate over the necessity of TGC, its goals, the risk of severe hypoglycemia, and target cohorts.This paper provides a review of TGC via new analyses of data from several clinical trials, including SPRINT, Glucontrol and a recent NICU study. It thus provides both a review of the problem and major background factors driving it, as well as a novel model-based analysis designed to examine these dynamics from a new perspective. Using these clinical results and analysis, the goal is to develop new insights that shed greater light on the leading factors that make TGC difficult and inconsistent, as well as the requirements they thus impose on the design and implementation of TGC protocols.A model-based analysis of insulin sensitivity using data from three different critical care units, comprising over 75,000 hours of clinical data, is used to analyse variability in metabolic dynamics using a clinically validated model-based insulin sensitivity metric (S I ). Variation in S I provides a new interpretation and explanation for the variable results seen (across cohorts and studies) in applying TGC. In particular, significant intra-and inter-patient variability in insulin resistance (1/ S I ) is seen be a major confounder that makes TGC difficult over diverse cohorts, yielding variable results over many published studies and protocols. Further factors that exacerbate this variability in glycemic outcome are found to include measurement frequency and whether a protocol is blind to carbohydrate administration.

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“…The clinical pulmonary infection score (CPIS) 24 was recorded for each day of ventilation. The SOFA max score 25 was determined by summing the worst daily scores for each of the 6 components of the SOFA score over the data collection period. A CPIS max score was calculated by summing the worst daily scores of the 5 elements of the CPIS score.…”

Section: About the Authorsmentioning

confidence: 99%

Semirecumbent Positioning in Ventilator-Dependent Patients: A Multicenter, Observational Study

Rose¹,

Baldwin²,

Crawford³

et al. 2010

American Journal of Critical Care

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Background Positioning of patients is a modifiable risk factor for ventilator-associated pneumonia. Current guidelines for prevention of ventilator-associated pneumonia recommend semirecumbency at 30º, with 45º preferable unless contraindicated. Objective To assess the use of semirecumbency for ventilator patients in Australian and New Zealand intensive care units. Methods In a multicenter, observational study, backrest elevation, mean arterial pressure, use of inotropic agents, enteral feeding, and weaning status were recorded 3 times per day by using a predetermined randomization schedule for 7 consecutive days (maximum 21 observation episodes). Severity of illness was recorded daily by using the Sepsis-Related Organ Failure Assessment (SOFA) score. Results Measurements (n = 2112) were recorded for 371 ventilator patients in 32 intensive care units. Backrest elevation at ≥45º was noted for 112 of 2112 (5.3%; 95% confidence interval [CI], 4.3-6.3) measurements; elevation ≥30º but <45º for 472 of 2112 (22.3%; 95% CI, 20.6-24.1). Contraindications to semirecumbency were noted during 447 measurements. Increased backrest elevation occurred during enteral feeding (2.2º, P < .001) and weaning (3.1º, P < .001). Decreased backrest elevation was associated with inotropic support (2.8º, P < .001), decreased mean arterial pressure (0.7º/10 mm Hg, P < .001), and organ failure (0.5º/1-point increment in SOFA max score, P < .001). For measurements recorded with no contraindication to semirecumbency, weaning status (P = .003) and SOFA max score (P = .008) remained associated with the degree of backrest elevation. Conclusions The findings of this multicenter, observational study suggest that backrest elevation was less than recommended and was influenced by clinical practices and patient condition.

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The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study

Cited by 782 publications

References 57 publications

Neuroanesthesia and Intensive Care Limited ability of SOFA and MOD scores to discriminate outcome: a prospective evaluation in 1,436 patients

Neuroanesthesia and Intensive Care Limited ability of SOFA and MOD scores to discriminate outcome: a prospective evaluation in 1,436 patients

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

Semirecumbent Positioning in Ventilator-Dependent Patients: A Multicenter, Observational Study

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