Usefulness of Measuring Changes in SOFA Score for the Prediction of 28-Day Mortality in Patients With Sepsis-Associated Disseminated Intravascular Coagulation

Iba, Toshiaki; Arakawa, Makoto; Mochizuki, Kiyofumi; Nishida, Osamu; Wada, Hideo; Levy, Jerrold H.

doi:10.1177/1076029618824044

Cited by 33 publications

(44 citation statements)

References 35 publications

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“…In addition, patients receiving TPE in our study had improved SOFA and cardiac SOFA scores at 48 h, indicating improved organ function and hemodynamics. While the predicted mortality based on SOFA scores may be overstated, trends in SOFA scores serve as valuable predictors of outcomes [37][38][39]. Fortenberry and colleagues reported improvement in organ dysfunction (as reflected by changes in PELOD scores from baseline) and 28-day mortality in septic pediatric patients meeting similar criteria who received TPE [37].…”

Section: Discussionmentioning

confidence: 99%

The therapeutic efficacy of adjunct therapeutic plasma exchange for septic shock with multiple organ failure: a single-center experience

et al. 2020

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Background: Sepsis remains a common condition with high mortality when multiple organ failure develops. The evidence for therapeutic plasma exchange (TPE) in this setting is promising but inconclusive. Our study aims to evaluate the efficacy of adjunct TPE for septic shock with multiple organ failure compared to standard therapy alone. Methods: A retrospective, observational chart review was performed, evaluating outcomes of patients with catecholamine-resistant septic shock and multiple organ failure in intensive care units at a tertiary care hospital in Winston-Salem, NC, from August 2015 to March 2019. Adult patients with catecholamine-resistant septic shock (≥ 2 vasopressors) and evidence of multiple organ failure were included. Patients who received adjunct TPE were identified and compared to patients who received standard care alone. A propensity score using age, gender, chronic co-morbidities (HTN, DM, CKD, COPD), APACHE II score, SOFA score, lactate level, and number of vasopressors was used to match patients, resulting in 40 patients in each arm. Results: The mean baseline APACHE II and SOFA scores were 32.5 and 14.3 in TPE patients versus 32.7 and 13.8 in control patients, respectively. The 28-day mortality rate was 40% in the TPE group versus 65% in the standard care group (p = 0.043). Improvements in baseline SOFA scores at 48 h were greater in the TPE group compared to standard care alone (p = 0.001), and patients receiving adjunct TPE had a more favorable fluid balance at 48 h (p = 0.01). Patients receiving adjunct TPE had longer ICU and hospital lengths of stay (p = 0.003 and p = 0.006, respectively). Conclusions: Our retrospective, observational study in adult patients with septic shock and multiple organ failure demonstrated improved 28-day survival with adjunct TPE compared to standard care alone. Hemodynamics, organ dysfunction, and fluid balance all improved with adjunct TPE, while lengths of stay were increased in survivors. The study design does not allow for a generalized statement of support for TPE in all cases of sepsis with multiple organ failure but offers valuable information for a prospective, randomized clinical trial.

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Section: Discussionmentioning

confidence: 99%

The therapeutic efficacy of adjunct therapeutic plasma exchange for septic shock with multiple organ failure: a single-center experience

et al. 2020

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“…In the current study, we evaluated the predictive performance for 28-day mortality using a new scoring system, the SOFA Comb , calculated by SOFA Δ + absolute SOFA score, and validated its potential applicability using a sepsis-associated DIC patient database. We previously reported the superiority of SOFA Δ compared to DIC scores [21], and our goal was to improve the performance of SOFA Δ in the present study. The performance of SOFA Δ has been repeatedly validated for predicting the prognosis in sepsis patients, but the results are inconsistent.…”

Section: Discussionmentioning

confidence: 97%

A New SOFA Score Calculation to Improve the Predictive Performance for Mortality

Arakawa

Levy

Kondo

et al. 2020

Preprint

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Background: The sequential organ failure assessment (SOFA) is one of the most commonly used scoring systems to evaluate organ failure in sepsis. The trajectory of the SOFA score, a delta-SOFA (SOFAΔ), is proposed as a better indicator for predicting mortality, and potentially as an endpoint in exploratory clinical trials. However, there are some concerns about the use of SOFAΔ. For example, SOFAΔ represents only the changes in the score, and the potential value of the absolute SOFA score has not been considered. Therefore, we hypothesized that the addition of the absolute SOFA score to the SOFAΔ would improve the predictive performance for patient outcomes. Based on this theory, a new indicator, SOFAComb calculated by SOFAΔ + absolute SOFA score, was examined in this study. Methods: Data obtained from 297 patients in multiinstitutional post-marketing surveys performed during June 2014, and May 2016 were retrospectively analyzed. All patients were diagnosed as having sepsis-associated disseminated intravascular coagulopathy (DIC) and treated with antithrombin concentrate. The SOFAComb and SOFAΔ were calculated on days 2, 4, and 7, and the performance was analyzed in terms of predictive ability for 28-day mortality.Results: Of the 297 patients included in the analysis, 214 patients survived (72.1%), while 83 patients (27.9%) died. The area under the receiver operating curve (AUC) of SOFA at baseline for predicting 28-mortality was 0.679. The AUCs of SOFAΔ on day 2, 4, 7 were 0.662, 0.769, 0.815, respectively, and those of SOFAComb on day 2, 4, 7 were 0.765, 0.830, 0.866, respectively. The AUCs of SOFAComb were significantly greater at all time points compared to SOFAΔ (day 2: P <0.001, day 4: P =0.002, day 7: P <0.001). In addition, the accuracy of SOFAComb was better than that of SOFAΔ (day 2: P <0.001, day 4: P =0.067, day 7: P =0.049). Conclusions: SOFAComb is simple to calculate and provides better predictive performance compared to SOFAΔ for predicting mortality. Additional studies are needed to confirm these findings.

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“…In addition, patients receiving TPE in our trial had improved SOFA and cardiac SOFA scores at 48 hours, indicating improved organ function and hemodynamics. While the predicted mortality based on SOFA scores may be overstated, trends in SOFA scores serve as valuable predictors of outcomes (37,38,39). Fortenberry and colleagues reported improvement in organ dysfunction (as re ected by changes in PELOD scores from baseline) and 28-day mortality in septic pediatric patients meeting similar criteria who received TPE (37).…”

Section: Discussionmentioning

confidence: 99%

The Therapeutic Efficacy of Adjunct Therapeutic Plasma Exchange for Septic Shock with Multiple Organ Failure: A Single Center Retrospective Review

Keith

Wells

Hodges

et al. 2020

Preprint

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Background: Sepsis remains a common condition with high mortality when multiple organ failure develops. The evidence for therapeutic plasma exchange (TPE) in this setting is promising but inconclusive. Our study aims to evaluate the efficacy of adjunct TPE for septic shock with multiple organ failure compared to standard therapy alone. Methods: A retrospective, observational chart review was performed, evaluating outcomes of patients with catecholamine resistant septic shock and multiple organ failure in Intensive Care Units at a tertiary care hospital in Winston Salem, North Carolina from August 2015- March 2019. Adult patients with catecholamine resistant septic shock (≥ 2 vasopressors) and evidence of multiple organ failure were included. Patients who received adjunct TPE were identified and compared to patients who received standard care alone. A propensity score using age, gender, chronic co-morbidities (HTN, DM, CKD, COPD), APACHE II score, SOFA score, lactate level, and number of vasopressors was used to match patients, resulting in 40 patients in each arm. Results: Mean baseline APACHE II and SOFA scores were 32.5 and 14.3 in TPE patients versus 32.7 and 13.8 in control patients. The 28-day mortality rate was 40% in the TPE group versus 65% in the standard care group (p=0.043). Improvements in baseline SOFA scores at 48 hours were greater in the TPE group compared to standard care alone (p=0.001), and patients receiving adjunct TPE had a more favorable fluid balance at 48 hours (p=0.01). Patients receiving adjunct TPE had longer ICU and hospital lengths of stay (p=0.003 and p=0.006). Conclusions: Our retrospective, observational study in adult patients with septic shock and multiple organ failure demonstrated improved 28-day survival with adjunct TPE compared to standard care alone. Hemodynamics, organ dysfunction, and fluid balance all improved with adjunct TPE, while lengths of stay were increased in survivors. The study design does not allow for a generalized statement of support for TPE in all cases of sepsis with multiple organ failure but offers valuable information for a prospective, randomized clinical trial.

show abstract

Usefulness of Measuring Changes in SOFA Score for the Prediction of 28-Day Mortality in Patients With Sepsis-Associated Disseminated Intravascular Coagulation

Cited by 33 publications

References 35 publications

The therapeutic efficacy of adjunct therapeutic plasma exchange for septic shock with multiple organ failure: a single-center experience

The therapeutic efficacy of adjunct therapeutic plasma exchange for septic shock with multiple organ failure: a single-center experience

A New SOFA Score Calculation to Improve the Predictive Performance for Mortality

The Therapeutic Efficacy of Adjunct Therapeutic Plasma Exchange for Septic Shock with Multiple Organ Failure: A Single Center Retrospective Review

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