Predictive value of the Sequential Organ Failure Assessment score for mortality in a contemporary cardiac intensive care unit population

Jacob C. Jentzer, Courtney Bennett, Brandon M. Wiley, Dennis H. Murphree, Mark T. Keegan, Ognjen Gajic, R. Scott Wright, Gregory W. Barsness

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background--Optimal methods of mortality risk stratification in patients in the cardiac intensive care unit (CICU) remain uncertain. We evaluated the ability of the Sequential Organ Failure Assessment (SOFA) score to predict mortality in a large cohort of unselected patients in the CICU. Methods and Results--Adult patients admitted to the CICU from January 1, 2007, to December 31, 2015, at a single tertiary care hospital were retrospectively reviewed. SOFA scores were calculated daily, and Acute Physiology and Chronic Health Evaluation (APACHE)-III and APACHE-IV scores were calculated on CICU day 1. Discrimination of hospital mortality was assessed using area under the receiver-operator characteristic curve values. We included 9961 patients, with a mean age of 67.5±15.2 years; all-cause hospital mortality was 9.0%. Day 1 SOFA score predicted hospital mortality, with an area under the receiver-operator characteristic curve value of 0.83; area under the receiver-operator characteristic curve values were similar for the APACHE-III score, and APACHE-IV predicted mortality (P > 0.05). Mean and maximum SOFA scores over multiple CICU days had greater discrimination for hospital mortality (P < 0.01). Patients with an increasing SOFA score from day 1 and day 2 had higher mortality. Patients with day 1 SOFA score < 2 were at low risk of mortality. Increasing tertiles of day 1 SOFA score predicted higher long-term mortality (P < 0.001 by log-rank test). Conclusions--The day 1 SOFA score has good discrimination for short-term mortality in unselected patients in the CICU, which is comparable to APACHE-III and APACHE-IV. Advantages of the SOFA score over APACHE include simplicity, improved discrimination using serial scores, and prediction of long-term mortality.

Original languageEnglish (US)
Article numbere008169
JournalJournal of the American Heart Association
Volume7
Issue number6
DOIs
StatePublished - Mar 20 2018

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Organ Dysfunction Scores
APACHE
Intensive Care Units
Mortality
Population
Hospital Mortality
Tertiary Healthcare
Tertiary Care Centers

Keywords

  • Acute physiology and chronic health evaluation score
  • Cardiac critical care
  • Cardiac intensive care unit
  • Critical care
  • Intensive cardiac care unit
  • Intensive care unit
  • Mortality
  • Risk prediction
  • Sequential Organ Failure Assessment score

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Predictive value of the Sequential Organ Failure Assessment score for mortality in a contemporary cardiac intensive care unit population. / Jentzer, Jacob C.; Bennett, Courtney; Wiley, Brandon M.; Murphree, Dennis H.; Keegan, Mark T.; Gajic, Ognjen; Scott Wright, R.; Barsness, Gregory W.

In: Journal of the American Heart Association, Vol. 7, No. 6, e008169, 20.03.2018.

Research output: Contribution to journalArticle

Jentzer, Jacob C. ; Bennett, Courtney ; Wiley, Brandon M. ; Murphree, Dennis H. ; Keegan, Mark T. ; Gajic, Ognjen ; Scott Wright, R. ; Barsness, Gregory W. / Predictive value of the Sequential Organ Failure Assessment score for mortality in a contemporary cardiac intensive care unit population. In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 6.
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abstract = "Background--Optimal methods of mortality risk stratification in patients in the cardiac intensive care unit (CICU) remain uncertain. We evaluated the ability of the Sequential Organ Failure Assessment (SOFA) score to predict mortality in a large cohort of unselected patients in the CICU. Methods and Results--Adult patients admitted to the CICU from January 1, 2007, to December 31, 2015, at a single tertiary care hospital were retrospectively reviewed. SOFA scores were calculated daily, and Acute Physiology and Chronic Health Evaluation (APACHE)-III and APACHE-IV scores were calculated on CICU day 1. Discrimination of hospital mortality was assessed using area under the receiver-operator characteristic curve values. We included 9961 patients, with a mean age of 67.5±15.2 years; all-cause hospital mortality was 9.0{\%}. Day 1 SOFA score predicted hospital mortality, with an area under the receiver-operator characteristic curve value of 0.83; area under the receiver-operator characteristic curve values were similar for the APACHE-III score, and APACHE-IV predicted mortality (P > 0.05). Mean and maximum SOFA scores over multiple CICU days had greater discrimination for hospital mortality (P < 0.01). Patients with an increasing SOFA score from day 1 and day 2 had higher mortality. Patients with day 1 SOFA score < 2 were at low risk of mortality. Increasing tertiles of day 1 SOFA score predicted higher long-term mortality (P < 0.001 by log-rank test). Conclusions--The day 1 SOFA score has good discrimination for short-term mortality in unselected patients in the CICU, which is comparable to APACHE-III and APACHE-IV. Advantages of the SOFA score over APACHE include simplicity, improved discrimination using serial scores, and prediction of long-term mortality.",
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T1 - Predictive value of the Sequential Organ Failure Assessment score for mortality in a contemporary cardiac intensive care unit population

AU - Jentzer, Jacob C.

AU - Bennett, Courtney

AU - Wiley, Brandon M.

AU - Murphree, Dennis H.

AU - Keegan, Mark T.

AU - Gajic, Ognjen

AU - Scott Wright, R.

AU - Barsness, Gregory W.

PY - 2018/3/20

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N2 - Background--Optimal methods of mortality risk stratification in patients in the cardiac intensive care unit (CICU) remain uncertain. We evaluated the ability of the Sequential Organ Failure Assessment (SOFA) score to predict mortality in a large cohort of unselected patients in the CICU. Methods and Results--Adult patients admitted to the CICU from January 1, 2007, to December 31, 2015, at a single tertiary care hospital were retrospectively reviewed. SOFA scores were calculated daily, and Acute Physiology and Chronic Health Evaluation (APACHE)-III and APACHE-IV scores were calculated on CICU day 1. Discrimination of hospital mortality was assessed using area under the receiver-operator characteristic curve values. We included 9961 patients, with a mean age of 67.5±15.2 years; all-cause hospital mortality was 9.0%. Day 1 SOFA score predicted hospital mortality, with an area under the receiver-operator characteristic curve value of 0.83; area under the receiver-operator characteristic curve values were similar for the APACHE-III score, and APACHE-IV predicted mortality (P > 0.05). Mean and maximum SOFA scores over multiple CICU days had greater discrimination for hospital mortality (P < 0.01). Patients with an increasing SOFA score from day 1 and day 2 had higher mortality. Patients with day 1 SOFA score < 2 were at low risk of mortality. Increasing tertiles of day 1 SOFA score predicted higher long-term mortality (P < 0.001 by log-rank test). Conclusions--The day 1 SOFA score has good discrimination for short-term mortality in unselected patients in the CICU, which is comparable to APACHE-III and APACHE-IV. Advantages of the SOFA score over APACHE include simplicity, improved discrimination using serial scores, and prediction of long-term mortality.

AB - Background--Optimal methods of mortality risk stratification in patients in the cardiac intensive care unit (CICU) remain uncertain. We evaluated the ability of the Sequential Organ Failure Assessment (SOFA) score to predict mortality in a large cohort of unselected patients in the CICU. Methods and Results--Adult patients admitted to the CICU from January 1, 2007, to December 31, 2015, at a single tertiary care hospital were retrospectively reviewed. SOFA scores were calculated daily, and Acute Physiology and Chronic Health Evaluation (APACHE)-III and APACHE-IV scores were calculated on CICU day 1. Discrimination of hospital mortality was assessed using area under the receiver-operator characteristic curve values. We included 9961 patients, with a mean age of 67.5±15.2 years; all-cause hospital mortality was 9.0%. Day 1 SOFA score predicted hospital mortality, with an area under the receiver-operator characteristic curve value of 0.83; area under the receiver-operator characteristic curve values were similar for the APACHE-III score, and APACHE-IV predicted mortality (P > 0.05). Mean and maximum SOFA scores over multiple CICU days had greater discrimination for hospital mortality (P < 0.01). Patients with an increasing SOFA score from day 1 and day 2 had higher mortality. Patients with day 1 SOFA score < 2 were at low risk of mortality. Increasing tertiles of day 1 SOFA score predicted higher long-term mortality (P < 0.001 by log-rank test). Conclusions--The day 1 SOFA score has good discrimination for short-term mortality in unselected patients in the CICU, which is comparable to APACHE-III and APACHE-IV. Advantages of the SOFA score over APACHE include simplicity, improved discrimination using serial scores, and prediction of long-term mortality.

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KW - Critical care

KW - Intensive cardiac care unit

KW - Intensive care unit

KW - Mortality

KW - Risk prediction

KW - Sequential Organ Failure Assessment score

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