Use of the Sequential Organ Failure Assessment score for evaluating outcome among obstetric patients admitted to the intensive care unit

Abstract

In terms of discriminatory power for predicting mortality among obstetric patients admitted to the ICU, total SOFA score at admission was the most relevant, simple, and accurate measure.

The Utility of the Sequential Organ Failure Assessment Score in Predicting Mortality in Critically Ill Obstetric Patients Admitted to a High Dependency Unit in Uganda

“…The SOFA score offers several advantages [26][27][28][29][30]: it uses variables that can be easily measured without the need of very complex resources, proxy measures could be used in cases where complex or expensive variables cannot be measured, measurements can easily be standardized, and scores have high predictive and discriminatory ability in SMM. As in other studies [12][13][14][21][22][23][24]26], the maximum aggregated SOFA scores were prognostic, though in retrospect. In our study, the 95% confidence limits of the point estimates for the area under ROC curves of nearly all the systems showed that upper limits were >0.75 for all organs, indicates that severe obstetric morbidity is associated with multiple organ/system dysfunction.…”

“…Scores based on criteria of organ/system dysfunction or failure, such as SOFA scores, have greater discriminatory power in cases of SMM [6,7,9,14,21]. Consequently, women who survive SMM after presenting with high SOFA scores may be classified as maternal near miss, as the high SOFA scores represent severe organ/system dysfunction or failure [1,[11][12][13][14][15] during their hospitalization.…”

“…In our study, the 95% confidence limits of the point estimates for the area under ROC curves of nearly all the systems showed that upper limits were >0.75 for all organs, indicates that severe obstetric morbidity is associated with multiple organ/system dysfunction. Indeed values of ≥ 10 or ≥ 12 significantly increase the probability of maternal deaths [12][13][14][21][22][23][24].…”

“…It employs parameters from six organ systems-respiratory, cardiovascular, central nervous systems, renal, coagulation, and liver which are weighted (each 1-4) to give a final score [6-24 (maximum)]. The SOFA score has since then been validated to describe organ dysfunction in diverse patients with obstetric complications unrelated to sepsis [9][10][11] and has been validated to quantify the severity and extent of organ dysfunction and to predict prognosis for severely ill patients [12][13][14][15]. As the organ system functioning worsens, the score increases.…”

“…Studies that have evaluated SMM in intensive care units (ICU) have reported that the degree of organ dysfunction, the number of failing organs, and the duration of the condition are directly related to higher maternal mortality [12][13][14][15]. Prior studies have revealed high maternal morbidity and mortality related to severe obstetric complications in our setting [16,17].…”