Serial Evaluation of Sequential Organ Failure Assessment Score (SOFA) as a Predictor of Outcome in Children Admitted in Pediatric Intensive Care Unit (PICU) at Tertiary Care Hospital
Amoolya Lois, Sushma Save
Morbidity, Mortality, Multiorgan dysfunction syndrome, Pediatric intensive care unit, Sequential organ failure Assessment score
Citation Information :
Lois A, Save S. Serial Evaluation of Sequential Organ Failure Assessment Score (SOFA) as a Predictor of Outcome in Children Admitted in Pediatric Intensive Care Unit (PICU) at Tertiary Care Hospital. Indian J Crit Care Med 2023; 27 (8):590-595.
Background: Sequential organ failure assessment score (SOFA) is a score to quantify organ system dysfunction. This study was done to evaluate SOFA as a predictor of outcomes in children in pediatric intensive care unit (PICU).
Objective: (A) To determine whether initial SOFA, Delta SOFA, and SOFA score at 72 hours are better predictors of outcome in terms of sensitivity and specificity. (B) To compare the initial SOFA, Delta SOFA, and SOFA score at 72 hours.
Materials and methods: A prospective observational study was conducted on 160 patients aged from 29 days to 12 years admitted in PICU of a Tertiary Care Hospital in a metropolitan city in India for a period of 1 year. Then, the initial SOFA score, 72-hour SOFA, and Delta SOFA (T0 SOFA - T72 SOFA) were calculated and patients were followed up till discharge from PICU or deceased.
Results: The best threshold to differentiate between discharged and deceased corresponds to as initial SOFA of 7.50 with a sensitivity of 64.71%, and specificity of 89.51%. The similar threshold for 72 hours SOFA is 10.50 which correspond to a sensitivity of 76.47% and specificity of 96.50%. The study showed strong evidence (p-value < 0.05) that, patients whose Delta SOFA values increased from the previous value (–1.5), had a greater chance to succumb to illness. Delta SOFA had the best sensitivity (82.35%) and 72-hour SOFA had the best specificity (96.50%) in predicting the outcome of PICU patients.
Conclusion: This study emphasizes the use of SOFA score as a prognostic indicator in critically ill children, as variables measured are easily available.
Tan GH, Tan TH, Goh DY, Yap HK. Risk factors for predicting mortality in a pediatric intensive care unit. Ann Acad Med Singap 1998;27(6): 813–818. PMID: 10101556.
Proulx F, Fayon M, Farrell CA, Lacroix J, Gauthier M. Epidemiology of sepsis and multiple organ dysfunction syndrome in children. Chest 1996;109(4):1033–1037. DOI: 10.1378/chest.109.4.1033.
Tantaleán JA, León RJ, Santos AA, Sánchez E. Multiple organ dysfunction syndrome in children. Pediatr Crit Care Med 2003;4(2): 181–185. DOI: 10.1097/01.PCC.0000059421.13161.88.
Jones AE, Trzeciak S, Kline JA. The sequential organ failure assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation. Crit Care Med 2009;37(5):1649–1654. DOI: 10.1097/CCM.0b013e31819def97.
Khilnani P, Sarma D, Zimmerman J. Epidemiology and peculiarities of pediatric multiple organ dysfunction syndrome in New Delhi, India. Intensive Care Med 2006;32(11):1856–1862. DOI: 10.1007/s00134-006-0373-5.
Ferreira FL, Bota DP, Bross A, Mélot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 2001;286(14):1754–1758. DOI: 10.1001/jama.286.14.1754.
Marik PE, Taeb AM. SIRS, qSOFA and new sepsis definition. J Thorac Dis 2017;9(4):943–945. DOI: 10.21037/jtd.2017.03.125.
Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: A reliable descriptor of a complex clinical outcome. Crit Care Med 1995;23(10):1638–1652. DOI: 10.1097/00003246-199510000-00007.
Vincent JL, Ferreira F, Moreno R. Scoring systems for assessing organ dysfunction and survival. Crit Care Clin 2000;16(2):353–366. DOI: 10.1016/s0749-0704(05)70114-7.
Mishra R, Chakrabarty J, Sequira L. A study to assess the patient clinical outcome using sofa score among patients admitted to ICU of tertiary hospital of South India. Int J Health Sci Res 2018;8(2):164–170. DOI: https://doi.org/10.52403/ijhsr.
Sayed AS, Abd El Haie OM, Shehata AA. Sequential organ failure assessment [SOFA] score in the pediatric intensive care unit. Benha Journal of Applied Sciences 2019;4(1):1–7. DOI: 10.21608/BJAS.2018.191149.
Gogia P, Prasad S. Utility of sequential organ failure assessment score in prognosticating sick children in pediatric intensive care unit. Int J Contemp Pediatr 2016;3(4):1193–1196. DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20163514.
Lalitha AV, Satish JK, Reddy M, Ghosh S, George J, Pujari C. Sequential organ failure assessment score as a predictor of outcome in sepsis in pediatric intensive care unit. J Pediatr Intensive Care 2021;10(2): 110–117. DOI: 10.1055/s-0040-1714705.
Mohamed El-Mashad G, Said El-Mekkawy M, Helmy Zayan M. Paediatric sequential organ failure assessment (pSOFA) score: A new mortality prediction score in the paediatric intensive care unit. An Pediatr (Engl Ed) 2020;92(5):277–285. DOI: 10.1016/j.anpedi.2019.05.018.
Matics TJ, Sanchez-Pinto LN. Adaptation and validation of a pediatric sequential organ failure assessment score and evaluation of the sepsis-3 definitions in critically ill children. JAMA Pediatr 2017;171(10):e172352. DOI: 10.1001/jamapediatrics.2017.2352.
Nair R, Bhandary NM, D'Souza AD. Initial sequential organ failure assessment score versus simplified acute physiology score to analyze multiple organ dysfunction in infectious diseases in intensive care unit. Indian J Crit Care Med 2016;20(4):210–215. DOI: 10.4103/0972-5229.180041.
Gogia P, Koreti S, Patel GS. SOFA (sequential organ failure assessment) and PELOD (pediatric logistic organ dysfunction). Sch J App Med Sci 2015;3(4A):1645–1648. DOI: 10.36347/sjams.2015.v03i04.006.
Taha El-keiy M, Aly AM, Soliman Hammad K, Mohamed EE. Application study of five different scoring systems for assessment of illness severity and their relation to patients outcome at pediatric intensive care unit of BAB EL-SHA'REYA University Hospital. Al-Azhar Journal of Ped 2017;20(1):1702–1017. DOI: 10.21608/azjp.2017.77319.
Balasubramanian P, Sharma N, Biswal M, Bhalla A, Kumar S, Kumar V. Critical illness scoring systems: Sequential organ failure assessment, acute physiology and chronic health evaluation II, and quick sequential organ failure assessment to predict the clinical outcomes in scrub typhus patients with organ dysfunctions. Indian J Crit Care Med 2018;22(10):706–710. DOI: 10.4103/ijccm.IJCCM_254_18.