Initial Sequential Organ Failure Assessment score versus Simplified Acute Physiology score to analyze multiple organ dysfunction in infectious diseases in Intensive Care Unit
Remyasri Nair, Nithish M. Bhandary, Ashton D. D′Souza
Keywords :
Mortality, multiple organ dysfunction, Sequential Organ Failure Assessment score, Simplified Acute Physiology score
Citation Information :
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.
Aims: To investigate initial Sequential Organ Failure Assessment (SOFA) score of patients in Intensive Care Unit (ICU), who were diagnosed with infectious disease, as an indicator of multiple organ dysfunction and to examine if initial SOFA score is a better mortality predictor compared to Simplified Acute Physiology Score (SAPS).
Materials and Methods: Hospital-based study done in medical ICU, from June to September 2014 with a sample size of 48. Patients aged 18 years and above, diagnosed with infectious disease were included. Patients with history of chronic illness (renal/hepatic/pulmonary/ cardiovascular), diabetes, hypertension, chronic obstructive pulmonary disease, heart disease, those on immunosuppressive therapy/chemoradiotherapy for malignancy and patients in immunocompromised state were excluded. Blood investigations were obtained. Six organ dysfunctions were assessed using initial SOFA score and graded from 0 to 4. SAPS was calculated as the sum of points assigned to each of the 17 variables (12 physiological, age, type of admission, and three underlying diseases). The outcome measure was survival status at ICU discharge.
Results: We categorized infectious diseases into dengue fever, leptospirosis, malaria, respiratory tract infections, and others which included undiagnosed febrile illness, meningitis, urinary tract infection and gastroenteritis. Initial SOFA score was both sensitive and specific; SAPS lacked sensitivity. We found no significant association between age and survival status. Both SAPS and initial SOFA score were found to be statistically significant as mortality predictors. There is significant association of initial SOFA score in analyzing organ dysfunction in infectious diseases (P < 0.001). SAPS showed no statistical significance. There was statistically significant (P = 0.015) percentage of nonsurvivors with moderate and severe dysfunction, based on SOFA score. Nonsurvivors had higher SAPS but was not statistically significant (P = 0.094).
Conclusions: Initial SOFA score is a superior mortality predictor. It easily measures degree of organ dysfunction in infectious diseases and complements other scoring systems.
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707-10.
Metnitz PG, Valentin A, Vesely H, Alberti C, Lang T, Lenz K, et al. Prognostic performance and customization of the SAPS II: Results of a multicenter Austrian study. Simplified Acute Physiology Score. Intensive Care Med 1999;25:192-7.
Abhinandan KS, Vedavathi R. Usefulness of sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation II (APACHE II) score in analysing patients with multiple organ dysfunction syndrome in sepsis. J Evol Med Dent Sci 2013;2:9591-605.
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;286:1754-8.
Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993;270:2957-63.
Le Gall JR, Lemeshow S. The SAPS II: A new score with new objectives. In: Vincent JL, editor. Yearbook of Intensive Care and Emergency Medicine. Berlin: Springer Berlin; 1994. p. 795-804.
Katsaragakis S, Papadimitropoulos K, Antonakis P, Strergiopoulos S, Konstadoulakis MM, Androulakis G. Comparison of Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) scoring systems in a single Greek intensive care unit. Crit Care Med 62000;28:426-32.
Ho KM. Combining sequential organ failure assessment (SOFA) score with acute physiology and chronic health evaluation (APACHE) II score to predict hospital mortality of critically ill patients. Anaesth Intensive Care 2007;35:515-21.
Halim DA, Murni TW, Redjeki IS. Comparison of Apache II, SOFA, and modified SOFA scores in predicting mortality of surgical patients in intensive care unit at Dr. Hasan Sadikin General Hospital. Crit Care Shock 2009;12:157-69.
Minne L, Abu-Hanna A, de Jonge E. Evaluation of SOFA-based models for predicting mortality in the ICU: A systematic review. Crit Care 2008;12:R161.
Sakr Y, Krauss C, Amaral AC, Réa-Neto A, Specht M, Reinhart K, et al. Comparison of the performance of SAPS II, SAPS 3, APACHE II, and their customized prognostic models in a surgical intensive care unit. Br J Anaesth 2008;101:798-803.
Shrestha GS, Gurung R, Amatya R. Comparison of acute physiology, age, chronic health evaluation III score with initial sequential organ failure assessment score to predict ICU mortality. Nepal Med Coll J 2011;13:50-4.
Bale C, Kakrani AL, Dabadghao VS, Sharma ZD. Sequential organ failure assessment score as prognostic marker in critically ill patients in a tertiary care intensive care unit. Int J Med Public Health 2013;3:155.
Acharya SP, Pradhan B, Marhatta MN. Application of "the Sequential Organ Failure Assessment (SOFA) score" in predicting outcome in ICU patients with SIRS. Kathmandu Univ Med J (KUMJ) 2007;5:475-83.
