Evaluation of the SOFA score: a single-center experience of a medical intensive care unit in 303 consecutive patients with predominantly cardiovascular disorders

Objective: To evaluate the use of the Sequential Organ Failure Assessment ( SOFA) score, the total maximum SOFA (TMS) score, and a derived variable, th e Delta SOFA (TMS score minus total SOFA score on day 1) in medical, cardio vascular patients as a means for describing the incidence and severity of o rgan dysfunction and the prognostic value regarding outcome. Design: Prospective, clinical study. Setting: Medical intensive care unit in a university hospital. Patients: A total of 303 consecutive patients were included (216 men, 87 wo men; mean age 62 +/- 12.6 years; SAPS II 26.2 +/- 12.7). They were evaluate d 24 h after admission and thereafter every 24 h until ICU discharge or dea th between November 1997 and March 1998. Readmissions and patients with an ICU stay shorter than 12 h were excluded. Main outcome measure: Survival status at hospital discharge, incidence of o rgan dysfunction/failure. Interventions: Collection of clinical and demogra phic data and raw data for the computation of the SOFA score every 24 h unt il ICU discharge. Measurements and main results: Length of ICU stay was 3.7 +/- 4.7 days. ICU mortality was 8.3 % and hospital mortality 14.5 %. Nonsurvivors had a high er total SOFA score on day 1 (5.9 +/- 3.7 vs. 1.9 +/- 2.3, p < 0.001) and t hereafter until day 8. High SOFA scores for any organ system and increasing number of organ failures (SOFA score greater than or equal to 3) were asso ciated with increased mortality. Cardiovascular and neurological systems (d ay 1) were related to outcome and cardiovascular and respiratory systems, a nd admission from another ICU to length of ICU stay. TMS score was higher i n nonsurvivors (1.76 +/- 2.55 vs. 0.58 +/- 1.39, p < 0.01), and Delta SOFA/ total SOFA on day 1 was independently related to outcome. The area under th e receiver-operating characteristic curve was 0.86 for TMS, 0.82 for SOFA o n day 1, and 0.77 for SAPS II. Conclusions: The SOFA, TMS, and Delta SOFA scores provide the clinician wit h important information on degree and progression of organ dysfunction in m edical, cardiovascular patients. On day 1 both SOFA score and TMS score had a better prognostic value than SAPS II score. The model is closely related to outcome and identifies patients who are at increased risk for prolonged ICU stay.