TY - JOUR
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.
N1 - Publisher Copyright:
© 2018 The Authors.
PY - 2018/3/20
Y1 - 2018/3/20
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.
KW - Acute physiology and chronic health evaluation score
KW - Cardiac critical care
KW - Cardiac intensive care unit
KW - Critical care
KW - Intensive cardiac care unit
KW - Intensive care unit
KW - Mortality
KW - Risk prediction
KW - Sequential Organ Failure Assessment score
UR - http://www.scopus.com/inward/record.url?scp=85043702620&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85043702620&partnerID=8YFLogxK
U2 - 10.1161/JAHA.117.008169
DO - 10.1161/JAHA.117.008169
M3 - Article
C2 - 29525785
AN - SCOPUS:85043702620
SN - 2047-9980
VL - 7
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 6
M1 - e008169
ER -