Prognostic Accuracy of the Quick Sequential Organ Failure Assessment Score and National Early Warning Scores in mortality rate of the Non-Traumatic Patients (original) (raw)
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Scientifica, 2016
Background. The sequential organ failure assessment (SOFA) score has been recommended to triage critically ill patients in the intensive care unit (ICU). This study aimed to compare the performance of our proposed MSOFA and original SOFA scores in predicting ICU mortality. Methods. This prospective observational study was conducted on 250 patients admitted to the ICU. Both tools scores were calculated at the beginning, 24 hours of ICU admission, and 48 hours of ICU admission. Diagnostic odds ratio and receiver operating characteristic (ROC) curve were used to compare the two scores. Results. MSOFA and SOFA predicted mortality similarly with an area under the ROC curve of 0.837, 0.992, and 0.977 for MSOFA 1, MSOFA 2, and MSOFA 3, respectively, and 0.857, 0.988, and 0.988 for SOFA 1, SOFA 2, and SOFA 3, respectively. The sensitivity and specificity of MSOFA 1 in cut-off point 8 were 82.9% and 68.4%, respectively, MSOFA 2 in cut-off point 9.5 were 94.7% and 97.1%, respectively, and MSO...
Journal of Anaesthesiology Clinical Pharmacology, 2015
Background and Aims: The objective was to determine the accuracy of sequential organ failure assessment (SOFA) score in predicting outcome of patients in Intensive Care Unit (ICU). Material and Methods: Forty-four consecutive patients between 15 and 80 years admitted to ICU over 8 weeks period were studied prospectively. Three patients were excluded. SOFA score was determined 24 h postadmission to ICU and subsequently every 48 h for the first 10 days. Patients were followed till discharge/death/transfer from the ICU. Initial SOFA score, highest and mean SOFA scores were calculated and correlated with mortality and duration of stay in ICU. Results: The mortality rate was 39% and the mean duration of stay in the ICU was 9 days. The maximum score in survivors (3.92 ± 2.17) was significantly lower than nonsurvivors (8.9 ± 3.45). The initial SOFA score had a strong statistical correlation with mortality. Cardiovascular score on day 1 and 3, respiratory score on day 7, and coagulation profile on day 3 correlated significantly with the outcome. Duration of the stay did not correlate with the survival (P = 0.461). Conclusion: SOFA score is a simple, but effective prognostic indicator and evaluator for patient progress in ICU. Day 1 SOFA can triage the patients into risk categories. For further management, mean and maximum score help determine the severity of illness and can act as a guide for the intensity of therapy required for each patient.
Indian Journal of Critical Care Medicine
Aim and objective: To examine if sequential organ failure assessment (SOFA) alone or SOFA in combination with pH is a better prognosis and mortality indicator. Materials and methods: We conducted a prospective observational study in a total of sixty patients. The mortality of patients was predicted on the basis of a SOFA score alone or SOFA score in combination with pH, and the prediction by both was compared to the actual outcome. The comparison was based on the "standardized mortality ratio" and the "area under the receiver operating characteristic curve (AUROC). " Result: At the time of admission, both the scores (SOFA and SOFA with pH) were equally effective in predicting mortality. At 48 hours, SOFA with pH proves to be slightly better in mortality prediction than SOFA score alone. The discriminative power of both the scores was assessed by calculating AUROC. AUROC of the SOFA score was better than that of SOFA with pH at admission and at 48 hours, but statistically, both had the same level of discrimination, i.e., excellent. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were the same for both the scores at admission, but all parameters except specificity were better for SOFA with pH at 48 hours. Specificity was the same for both even at 48 hours. Conclusion: At the time of admission, SOFA score and SOFA with pH were equally effective in outcome prediction, but after 48 hours, SOFA with pH proves to be better than the SOFA score alone. The power of discrimination is the same for both the scores at admission and at 48 hours.
International Journal of Medicine and Public Health, 2013
Introduction: Sepsis is one of the most important causes of mortality in the intensive care setting. An effective predictor of prognosis of sepsis is required to assess morbidity and mortality of this condition. In this study, sepsis in the intensive care unit (ICU) of a tertiary care hospital was evaluated, with specifi c reference to clinical features and causative organisms. The sequential organ failure assessment (SOFA) score was calculated to assess the severity of sepsis and multi-organ failure at presentation and after 48 h. The correlation of SOFA and mean SOFA scores with outcome was studied. Materials and Methods: This was a prospective, observational, cohort study carried out in a tertiary care teaching hospital. Forty consecutive cases of septicemia were studied. Detailed history, clinical features, and SOFA score was recorded to assess the disease severity at the time of presentation and after 48 h. Inclusion of patients in the study was performed using the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) defi nition of sepsis. Two sample t-test and 95% confi dence interval (CI) for difference of mean was applied. Results: When the SOFA score was <7, the mortality was 56%. It increased to 70% when the score was 8-15 (P = 0.0989, t value: 1.69, Mean difference: 2.12, 95% CI: 0.41-4.665). Patients with SOFA score <7 after 48 h had 52% mortality and it increased to 88% when the score was 8-15. The mean SOFA score at 48 h was 6.96 in patients who died and 2.5 in those who improved (P < 0.001, t value: 4.332, mean difference: 4.39, 95% CI: 2.34-6.44). Hence, the predictive value for mortality of SOFA score was better at 48 h than at presentation. Conclusions: Sequential assessment of organ dysfunction in ICU at presentation and at 48 h is a good indicator of prognosis. Both mean and highest SOFA scores are particularly useful predictors of outcome, independent of the initial score. A high SOFA score at 48 h of presentation predicts an increased mortality rate.
Critical care medicine, 2015
Prediction models for ICU mortality rely heavily on physiologic variables that may not be available in large retrospective studies. An alternative approach when physiologic variables are absent stratifies mortality risk by acute organ failure classification. Retrospective cohort study. Two large teaching hospitals in Boston, MA. Ninety-two thousand eight hundred eighty-six patients aged 18 years old or older admitted between November 3, 1997, and February 25, 2011, who received critical care. None. The derivation cohort consisted of 35,566 patients from Brigham and Women's Hospital, and the validation cohort comprised 57,320 patients from Massachusetts General Hospital. Acute organ failure was determined for each patient based on International Classification of Diseases, 9th Revision, Clinical Modification code combinations. The main outcome measure was 30-day mortality. A clinical prediction model was created based on a logistic regression model describing the risk of 30-day mo...
The American Journal of Surgery, 2010
BACKGROUND: Prospective data regarding the prognostic value of the Sequential Organ Failure Assessment (SOFA) score in comparison with the Simplified Acute Physiology Score (SAPS II) and trauma scores on the outcome of multiple-trauma patients are lacking. METHODS: Single-center evaluation (n ϭ 237, Injury Severity Score [ISS] Ͼ16; mean ISS ϭ 29). Uni-and multivariate analysis of SAPS II, SOFA, revised trauma, polytrauma, and trauma and ISS scores (TRISS) was performed. RESULTS: The 30-day mortality was 22.8% (n ϭ 54). SOFA day 1 was significantly higher in nonsurvivors compared with survivors (P Ͻ .001) and correlated well with the length of intensive care unit stay (r ϭ .50, P Ͻ .001). Logistic regression revealed SAPS II to have the best predictive value of 30-day mortality (area under the receiver operating characteristic ϭ .86 Ϯ .03). The SOFA score significantly added prognostic information with regard to mortality to both SAPS II and TRISS. CONCLUSIONS: The combination of critically ill and trauma scores may increase the accuracy of mortality prediction in multiple-trauma patients.
2015
Aim.Toevaluate the impact of organdysfunction in severe sepsis anddetermine the effectiveness of organdysfunction scores to discriminate outcome after admission to the intensive care unit (ICU). Methods. Patients with a diagnosis of severe sepsis and at least one organ dysfunction on the first day in the ICU (n=117) were included in the prospective observational study. The presence of organ dysfunctionwas assessed using a Sequential Organ Failure Assessment (SOFA). The severity of illness was assessed using a Simplified Acute Physiol-ogy Score (SAPS) II during the first 24 hours after the admission to the ICU. The main outcome was survival status on day 28 after admission to the ICU. Results.Most common sites of infection were intra-abdominal and respiratory system (77 and 38 cases, respectively). Median SAPS II score on admissionwas 47 points (25th-75th quartiles range, 37-57 points). Twenty eight days survival ratewas 41%.Thebest discrimination resultswere shown for cumulative sco...
A Study on Mortality Outcomes in ICU Patients with Sequential Organ Failure Assessment (SOFA) Score
2015
PURPOSE OF THE PROJECT: This study intends to evaluate the usefulness of sequential organ failure assessment score (SOFA) in assessing organ dysfunction and risk of mortality in patients admitted to ICU. BACKGROUND: Outcome prediction is important in both clinical and administrative ICU management. It can be usefully applied to monitor the progress of an individual ICU. It also provides useful information on likely patient outcomes for critically ill patients and also for therapeutic decision making and using available resources efficiently. In an ICU setting serial organ function monitoring is important since there is a time to time variation in the general condition of the patient. Sequential Organ Failure Assessment (SOFA) is one such outcome prediction model to assess prognosis and mortality risk in ICU patients. DATA COLLECTION AND THE SOURCE: All adult patients admitted to the intensive care unit of Coimbatore Medical College Hospital will be included in the study. Blood sampl...
A modified sequential organ failure assessment score for critical care triage
Disaster medicine and public health preparedness, 2010
Objective: The Sequential Organ Failure Assessment (SOFA) score has been recommended for triage during a mass influx of critically ill patients, but it requires laboratory measurement of 4 parameters, which may be impractical with constrained resources. We hypothesized that a modified SOFA (MSOFA) score that requires only 1 laboratory measurement would predict patient outcome as effectively as the SOFA score. Methods: After a retrospective derivation in a prospective observational study in a 24-bed medical, surgical, and trauma intensive care unit, we determined serial SOFA and MSOFA scores on all patients admitted during the 2008 calendar year and compared the ability to predict mortality and the need for mechanical ventilation. Results: A total of 1770 patients (56% male patients) with a 30-day mortality of 10.5% were included in the study. Day 1 SOFA and MSOFA scores performed equally well at predicting mortality with an area under the receiver operating curve (AUC) of 0.83 (95% confidence interval 0.81-.85) and 0.84 (95% confidence interval 0.82-.85), respectively (P = .33 for comparison). Day 3 SOFA and MSOFA predicted mortality for the 828 patients remaining in the intensive care unit with an AUC of 0.78 and 0.79, respectively. Day 5 scores performed less well at predicting mortality. Day 1 SOFA and MSOFA predicted the need for mechanical ventilation on day 3, with an AUC of 0.83 and 0.82, respectively. Mortality for the highest category of SOFA and MSOFA score (>11 points) was 53% and 58%, respectively. Conclusions: The MSOFA predicts mortality as well as the SOFA and is easier to implement in resource-constrained settings, but using either score as a triage tool would exclude many patients who would otherwise survive.(Disaster Med Public Health Preparedness. 2010;4:277-284)(Received June 09 2010)(Accepted October 01 2010)
International Emergency Nursing, 2019
In this study our purpose is to examine the effectiveness and reliability of MEWS (Modified Early Warning Score), REMS (Rapid Emergency Medicine Score) and WPS (Worthing Physiological Scoring System) scoring systems for prediction of the prognosis and mortality rate of critically ill patients scheduled to be admitted to intensive care unit (ICU) among emergency department (ED) patients. Methods: This single-centered retrospective study was performed on medical, surgical and trauma patients referred to the ED and admitted to ICU of University Hospital between 23 July 2013 and 26 November 2015. Results: Mortality and the duration of stay in ICU were significantly correlated with systolic blood pressure (SBP) and WPS score compared to other variables (p = 0.014, p = 0.010 respectively). The decrease in SBP increased the mortality by 2 (OR: %95 CI 1.1-3.5) fold and the increase in WPS increased the mortality by 2.4 (OR: %95 CI 1.2-4.5) fold. Conclusions: In our study, there was a more significant correlation between WPS score and mortality and duration of stay in ICU compared to other scores.