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Jean Louis Vincent - One of the best experts on this subject based on the ideXlab platform.
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the early change of SOFA Score as a prognostic marker of 28 day sepsis mortality analysis through a derivation and a validation cohort
Critical Care, 2019Co-Authors: Eleni Karakike, Jean Louis Vincent, Christina Routsi, Evdoxia Kyriazopoulou, Iraklis Tsangaris, Evangelos J GiamarellosbourboulisAbstract:Since the Sepsis-3 criteria, change in Sequential Organ Failure Assessment (SOFA) Score has become a key component of sepsis identification. Thus, it could be argued that reversal of this change (ΔSOFA) may reflect sepsis response and could be used as measure of efficacy in interventional trials. We aimed to assess the predictive performance of ΔSOFA for 28-day mortality. Data from two previously published randomized controlled trials were studied: the first reporting on patients with severe Gram-negative infections as a derivation cohort and the second reporting on patients with ventilator-associated pneumonia as a validation cohort. Only patients with sepsis according to the Sepsis-3 definition were included in this analysis. SOFA Scores were calculated on days 1, 2, 3, 5, 7, 14, and 28. We included 448 patients within the derivation cohort and 199 within the validation cohort. Mean SOFA Scores on day 1 were 6.06 ± 4.07 and 7.84 ± 3.39, and 28 day mortality 22.8% and 29.6%, respectively. In the derivation cohort, the earliest time point where ΔSOFA Score predicted mortality was day 7 (AUROC (95% CI) 0.84 (0.80–0.89); p < 0.001). The best tradeoff for prediction was found with 25% changes (78% sensitivity, 80% specificity); less than 25% decrease of admission SOFA was associated with increased mortality (odds ratio for death 14.87). This finding was confirmed in the validation cohort. ΔSOFA on day 7 is a useful early prognostic marker of 28-day mortality and could serve as an endpoint in future sepsis trials alongside mortality. ClinicalTrials.gov numbers NCT01223690 and NCT00297674
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application of the sequential organ failure assessment SOFA Score to bacteremic icu patients
Infection, 2007Co-Authors: Christina Routsi, Jean Louis Vincent, Maria Pratikaki, Christina Sotiropoulou, E Platsouka, Vasiliki Markaki, Olga Paniara, C RoussossAbstract:Patients admitted to intensive care units (ICUs) are at a high risk of acquiring blood stream infections. We examined whether SOFA Score on ICU admission and on the day of bacteremia can predict the occurrence of bacteremia and the outcome of bacteremic ICU patients. All patients admitted to a multidisciplinary ICU for more than 48 h from January 1, 2002 to December 31, 2004, were prospectively studied. Demographic, clinical and laboratory data were recorded on admission for all patients and additionally, on the day of the first bacteremic episode for those patients who developed bacteremia. Accordingly, APACHE II and SOFA Scores were calculated on the same day. A total of 185 patients developed one or more episodes of bacteremia, giving an incidence of 9.6 per 1,000 ICU days. The ICU mortality rate was 43.9% for bacteremic and 25.8% for the remaining patients (p < 0.001). Admission SOFA Score was independently associated with the occurrence of bacteremia (OR = 1.20, 95% CI: 1.11–1.26, p < 0.001). Among bacteremic patients, SOFA Score on the day of bacteremia was the only independent prognostic factor for outcome (OR = 1.44, 95% CI: 1.21–1.71, p < 0.001). When all patients were included in the multivariate analysis, admission SOFA (OR = 1.3, CI: 1.16–1.38, p < 0.001), APACHE II (OR = 1.1, CI: 1.02–1.11, p = 0.003) Score and the presence of bacteremia (OR = 1.8, CI: 1.1–2.9, p = 0.023) were independently associated with the outcome. Admission SOFA Score is independently associated with the occurrence of ICU-acquired bacteremia, whereas it is not sufficient to predict the outcome of patients who subsequently will develop this complication. However, SOFA Score on the first day of bacteremia is an independent prognostic factor for outcome in these patients.
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the multiple organ dysfunction Score mods versus the sequential organ failure assessment SOFA Score in outcome prediction
Intensive Care Medicine, 2002Co-Authors: Daliana Peres Bota, Christian Melot, Flavio Lopes Ferreira, Jean Louis VincentAbstract:Abstract Objective. To compare outcome prediction using the Multiple Organ Dysfunction Score (MODS) and the Sequential Organ Failure Assessment (SOFA), two of the systems most commonly used to evaluate organ dysfunction in the intensive care unit (ICU). Design. Prospective, observational study. Setting. Thirty-one-bed, university hospital ICU. Patients and participants. Nine hundred forty-nine ICU patients. Measurements and results. The MODS and the SOFA Score were calculated on admission and every 48 h until ICU discharge. The Acute Physiology and Chronic Health Evaluation (APACHE) II Score was calculated on admission. Areas under receiver operating characteristic (AUROC) curves were used to compare initial, 48 h, 96 h, maximum and final Scores. Of the 949 patients, 277 died (mortality rate 29.1%). Shock was observed in 329 patients (mortality rate 55.3%). There were no significant differences between the two Scores in terms of mortality prediction. Outcome prediction of the APACHE II Score was similar to the initial MODS and SOFA Score in all patients, and slightly worse in patients with shock. Using the Scores' cardiovascular components (CV), outcome prediction was better for the SOFA Score at all time intervals (initial AUROC SOFA CV 0.750 vs MODS CV 0.694, p<0.01; 48 h AUROC SOFA CV 0.732 vs MODS CV 0.675, p<0.01; and final AUROC SOFA CV 0.781 vs MODS CV 0.674, p<0.01). The same tendency was observed in patients with shock. There were no significant differences in outcome prediction for the other five organ systems. Conclusions. MODS and SOFA are reliable outcome predictors. Cardiovascular dysfunction is better related to outcome with the SOFA Score than with the MODS.
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serial evaluation of the SOFA Score to predict outcome in critically ill patients
JAMA, 2001Co-Authors: Flavio Lopez Ferreira, Daliana Peres Bota, Annette Bross, Christian Melot, Jean Louis VincentAbstract:ContextEvaluation of trends in organ dysfunction in critically ill patients may help predict outcome.ObjectiveTo determine the usefulness of repeated measurement the Sequential Organ Failure Assessment (SOFA) Score for prediction of mortality in intensive care unit (ICU) patients.DesignProspective, observational cohort study conducted from April 1 to July 31, 1999.SettingA 31-bed medicosurgical ICU at a university hospital in Belgium.PatientsThree hundred fifty-two consecutive patients (mean age, 59 years) admitted to the ICU for more than 24 hours for whom the SOFA Score was calculated on admission and every 48 hours until discharge.Main Outcome MeasuresInitial SOFA Score (0-24), Δ-SOFA Scores (differences between subsequent Scores), and the highest and mean SOFA Scores obtained during the ICU stay and their correlations with mortality.ResultsThe initial, highest, and mean SOFA Scores correlated well with mortality. Initial and highest Scores of more than 11 or mean Scores of more than 5 corresponded to mortality of more than 80%. The predictive value of the mean Score was independent of the length of ICU stay. In univariate analysis, mean and highest SOFA Scores had the strongest correlation with mortality, followed by Δ-SOFA and initial SOFA Scores. The area under the receiver operating characteristic curve was largest for highest Scores (0.90; SE, 0.02; P<.001 vs initial Score). When analyzing trends in the SOFA Score during the first 96 hours, regardless of the initial Score, the mortality rate was at least 50% when the Score increased, 27% to 35% when it remained unchanged, and less than 27% when it decreased. Differences in mortality were better predicted in the first 48 hours than in the subsequent 48 hours. There was no significant difference in the length of stay among these groups. Except for initial Scores of more than 11 (mortality rate >90%), a decreasing Score during the first 48 hours was associated with a mortality rate of less than 6%, while an unchanged or increasing Score was associated with a mortality rate of 37% when the initial Score was 2 to 7 and 60% when the initial Score was 8 to 11.ConclusionsSequential assessment of organ dysfunction during the first few days of ICU admission is a good indicator of prognosis. Both the mean and highest SOFA Scores are particularly useful predictors of outcome. Independent of the initial Score, an increase in SOFA Score during the first 48 hours in the ICU predicts a mortality rate of at least 50%.
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acute renal failure in the icu risk factors and outcome evaluated by the SOFA Score
Intensive Care Medicine, 2000Co-Authors: A De Mendonca, M Antonelli, Rui Moreno, Jean Louis Vincent, Charles L Sprung, Jukka Takala, Pm Suter, N M Dearden, Francis CantraineAbstract:Objectives: To describe risk factors for the development of acute renal failure (ARF) in a population of intensive care unit (ICU) patients, and the association of ARF with multiple organ failure (MOF) and outcome using the sequential organ failure assessment (SOFA) Score. Design: Prospective, multicenter, observational cohort analysis. Setting: Forty ICUs in 16 countries. Patients: All patients admitted to one of the participating ICUs in May 1995, except those who stayed in the ICU for less than 48 h after uncomplicated surgery, were included. After the exclusion of 38 patients with a history of chronic renal failure requiring renal replacement therapy, a total of 1411 patients were studied. Measurements and results: Of the patients, 348 (24.7 %) developed ARF, as diagnosed by a serum creatinine of 300 μmol/l (3.5 mg/dl) or more and/or a urine output of less than 500 ml/day. The most important risk factors for the development of ARF present on admission were acute circulatory or respiratory failure; age more than 65 years, presence of infection, past history of chronic heart failure (CHF), lymphoma or leukemia, or cirrhosis. ARF patients developed MOF earlier than non-ARF patients (median 24 vs 48 h after ICU admission, p < 0.05). ARF patients older than 65 years with a past history of CHF or with any organ failure on admission were most likely to develop MOF. ICU mortality was 3 times higher in ARF than in other patients (42.8 % vs 14.0 %, p < 0.01). Oliguric ARF was an independent risk factor for overall mortality as determined by a multivariate regression analysis (OR = 1.59 [CI 95 %: 1.23–2.06], p < 0.01). Infection increased the risk of death associated with all factors. Factors that increased the ICU mortality of ARF patients were a past history of hematologic malignancy, age more than 65 years, the number of failing organs on admission and the presence of acute cardiovascular failure. Conclusion: In ICU patients, the most important risk factors for ARF or mortality from ARF are often present on admission. During the ICU stay, other organ failures (especially cardiovascular) are important risk factors. Oliguric ARF was an independent risk factor for ICU mortality, and infection increased the contribution to mortality by other factors. The severity of circulatory shock was the most important factor influencing outcome in ARF patients.
D G Craig - One of the best experts on this subject based on the ideXlab platform.
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ptu 006 the sequential organ failure assessment SOFA Score is an effective triage marker following staggered paracetamol acetaminophen overdose
Gut, 2012Co-Authors: D G Craig, S Zafar, T Reid, Janice S Davidson, Kirsty Martin, P C Hayes, Kerry SimpsonAbstract:Introduction The Sequential Organ Failure Assessment (SOFA) Score is an effective triage marker following single time point paracetamol (acetaminophen) overdose, 1 but has not been evaluated following staggered paracetamol overdose. The aims of this study were to evaluate the prognostic accuracy of the SOFA Score in a cohort of severe acute liver injury patients following staggered paracetamol overdose. Methods Time-course analysis of 50 staggered paracetamol overdoses admitted to a tertiary liver centre. Individual laboratory samples were correlated with the corresponding clinical parameters in relation to time from admission, and the daily SOFA Score calculated. Results A total of 39/50 (78%) patients developed hepatic encephalopathy, and therefore acute liver failure. The area under the SOFA receiver operator characteristic for death/liver transplantation was 87.4 (95% CI 73.2 to 95.7), 94.3 (95% CI 82.5 to 99.1), and 98.4 (95% CI 84.3 to 100.0) at 0, 24, and 48 h respectively post-admission. A SOFA Score of Conclusion A SOFA Score Competing interests None declared. Reference 1. Craig DG , Reid TW, Martin KG, et al . The systemic inflammatory response syndrome and sequential organ failure assessment Scores are effective triage markers following paracetamol (acetaminophen) overdose. Aliment Pharmacol Ther 2011; 34 :219–28.
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the sequential organ failure assessment SOFA Score is an effective triage marker following staggered paracetamol acetaminophen overdose
Alimentary Pharmacology & Therapeutics, 2012Co-Authors: D G Craig, S Zafar, Janice S Davidson, Kirsty Martin, P C Hayes, T W D J Reid, Kenneth J SimpsonAbstract:Summary Background The sequential organ failure assessment (SOFA) Score is an effective triage marker following single time point paracetamol (acetaminophen) overdose, but has not been evaluated following staggered (multiple supratherapeutic doses over >8 h, resulting in cumulative dose of >4 g/day) overdoses. Aim To evaluate the prognostic accuracy of the SOFA Score following staggered paracetamol overdose. Methods Time-course analysis of 50 staggered paracetamol overdoses admitted to a tertiary liver centre. Individual timed laboratory samples were correlated with corresponding clinical parameters and the daily SOFA Scores were calculated. Results A total of 39/50 (78%) patients developed hepatic encephalopathy. The area under the SOFA receiver operator characteristic for death/liver transplantation was 87.4 (95% CI 73.2–95.7), 94.3 (95% CI 82.5–99.1), and 98.4 (95% CI 84.3–100.0) at 0, 24 and 48 h, respectively, postadmission. A SOFA Score of <6 at tertiary care admission predicted survival with a sensitivity of 100.0% (95% CI 76.8–100.0) and specificity of 58.3% (95% CI 40.8–74.5), compared with 85.7% (95% CI 60.6–97.4) and 75.0% (95% CI 65.2–79.5) , respectively, for the modified Kings College criteria. Only 2/21 patients with an admission SOFA Score <6 required renal replacement therapy or intracerebral pressure monitoring. SOFA significantly outperformed the Model for End-stage Liver Disease, but not APACHE II, at 0, 24-and 48-h following admission. Conclusions A SOFA Score <6 at tertiary care admission following a staggered paracetamol overdose,is associated with a good prognosis. Both the SOFA and APACHE II Scores could improve triage of high-risk staggered paracetamol overdose patients.
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the sequential organ failure assessment SOFA Score is prognostically superior to the model for end stage liver disease meld and meld variants following paracetamol acetaminophen overdose
Alimentary Pharmacology & Therapeutics, 2012Co-Authors: D G Craig, Janice S Davidson, Kirsty Martin, P C Hayes, T W D J Reid, E C Wright, Kenneth J SimpsonAbstract:Background The prognostic value of the model for end-stage liver disease (MELD) and sodium-based MELD variants in predicting survival following paracetamol overdose remains unclear. Aim To examine the prognostic accuracy of sodium-based MELD variants in paracetamol-induced acute liver injury compared with the sequential organ failure assessment (SOFA) Score. Methods Retrospective analysis of 138 single time point paracetamol overdoses admitted to a tertiary liver centre. Individual laboratory samples were correlated with the corresponding clinical parameters in relation to time post-overdose, and the daily MELD, MELD-Na, MELDNa, MESO, iMELD, UKELD, updated MELD and SOFA Scores were calculated. Results Sixty-six (47.8%) patients developed hepatic encephalopathy, of whom 7 were transplanted and 21 died without liver transplantation. SOFA had a significantly greater area under the receiver operator characteristic for the prediction of spontaneous survival compared with MELD at both 72 (P = 0.024) and 96 (P = 0.017) h post-overdose. None of the sodium-based MELD variants improved the prognostic accuracy of MELD. A SOFA Score >6 by 72 h or >7 by 96 h, post-overdose predicted death/transplantation with a negative predictive value of 96.9 (95% CI 90.2-99.4) and 98.8 (95% CI 93.6-99.9) respectively. SOFA and MELD had similar accuracy for predicting the development of hepatic encephalopathy (P = 0.493). Conclusions The SOFA Score is superior to MELD in predicting spontaneous survival following paracetamol-induced acute liver injury. Modification of the MELD Score to include serum sodium does not improve prognostic accuracy in this setting. SOFA may have potential as a quantitative triage marker following paracetamol overdose.
Kenneth J Simpson - One of the best experts on this subject based on the ideXlab platform.
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the sequential organ failure assessment SOFA Score is an effective triage marker following staggered paracetamol acetaminophen overdose
Alimentary Pharmacology & Therapeutics, 2012Co-Authors: D G Craig, S Zafar, Janice S Davidson, Kirsty Martin, P C Hayes, T W D J Reid, Kenneth J SimpsonAbstract:Summary Background The sequential organ failure assessment (SOFA) Score is an effective triage marker following single time point paracetamol (acetaminophen) overdose, but has not been evaluated following staggered (multiple supratherapeutic doses over >8 h, resulting in cumulative dose of >4 g/day) overdoses. Aim To evaluate the prognostic accuracy of the SOFA Score following staggered paracetamol overdose. Methods Time-course analysis of 50 staggered paracetamol overdoses admitted to a tertiary liver centre. Individual timed laboratory samples were correlated with corresponding clinical parameters and the daily SOFA Scores were calculated. Results A total of 39/50 (78%) patients developed hepatic encephalopathy. The area under the SOFA receiver operator characteristic for death/liver transplantation was 87.4 (95% CI 73.2–95.7), 94.3 (95% CI 82.5–99.1), and 98.4 (95% CI 84.3–100.0) at 0, 24 and 48 h, respectively, postadmission. A SOFA Score of <6 at tertiary care admission predicted survival with a sensitivity of 100.0% (95% CI 76.8–100.0) and specificity of 58.3% (95% CI 40.8–74.5), compared with 85.7% (95% CI 60.6–97.4) and 75.0% (95% CI 65.2–79.5) , respectively, for the modified Kings College criteria. Only 2/21 patients with an admission SOFA Score <6 required renal replacement therapy or intracerebral pressure monitoring. SOFA significantly outperformed the Model for End-stage Liver Disease, but not APACHE II, at 0, 24-and 48-h following admission. Conclusions A SOFA Score <6 at tertiary care admission following a staggered paracetamol overdose,is associated with a good prognosis. Both the SOFA and APACHE II Scores could improve triage of high-risk staggered paracetamol overdose patients.
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the sequential organ failure assessment SOFA Score is prognostically superior to the model for end stage liver disease meld and meld variants following paracetamol acetaminophen overdose
Alimentary Pharmacology & Therapeutics, 2012Co-Authors: D G Craig, Janice S Davidson, Kirsty Martin, P C Hayes, T W D J Reid, E C Wright, Kenneth J SimpsonAbstract:Background The prognostic value of the model for end-stage liver disease (MELD) and sodium-based MELD variants in predicting survival following paracetamol overdose remains unclear. Aim To examine the prognostic accuracy of sodium-based MELD variants in paracetamol-induced acute liver injury compared with the sequential organ failure assessment (SOFA) Score. Methods Retrospective analysis of 138 single time point paracetamol overdoses admitted to a tertiary liver centre. Individual laboratory samples were correlated with the corresponding clinical parameters in relation to time post-overdose, and the daily MELD, MELD-Na, MELDNa, MESO, iMELD, UKELD, updated MELD and SOFA Scores were calculated. Results Sixty-six (47.8%) patients developed hepatic encephalopathy, of whom 7 were transplanted and 21 died without liver transplantation. SOFA had a significantly greater area under the receiver operator characteristic for the prediction of spontaneous survival compared with MELD at both 72 (P = 0.024) and 96 (P = 0.017) h post-overdose. None of the sodium-based MELD variants improved the prognostic accuracy of MELD. A SOFA Score >6 by 72 h or >7 by 96 h, post-overdose predicted death/transplantation with a negative predictive value of 96.9 (95% CI 90.2-99.4) and 98.8 (95% CI 93.6-99.9) respectively. SOFA and MELD had similar accuracy for predicting the development of hepatic encephalopathy (P = 0.493). Conclusions The SOFA Score is superior to MELD in predicting spontaneous survival following paracetamol-induced acute liver injury. Modification of the MELD Score to include serum sodium does not improve prognostic accuracy in this setting. SOFA may have potential as a quantitative triage marker following paracetamol overdose.
Laurent Argaud - One of the best experts on this subject based on the ideXlab platform.
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a new simplified and accurate sa SOFA Score
Journal of Critical Care, 2020Co-Authors: Charlesherve Vacheron, Arnaud Friggeri, Jean Iwaz, Bernard Allaouchiche, Julien Bohe, Guillaume Monneret, Fabienne Venet, Martin Cour, Laurent ArgaudAbstract:Abstract Purpose Several remarks have been raised regarding the variables and cut-points used in the Sequential Organ Failure Assessment (SOFA) Score. This study revisited the SOFA Score and created a new simplified and accurate sa-SOFA Score. Methods The study grouped four prospective cohorts (2005–2016) of patients with Systemic Inflammatory Response Syndrome. It collected 28-day mortality, sociodemographic characteristics, and the SOFA Score with all variable values at Day 1. A logistic regression analysis was used to select the most relevant variables and a minimum p value approach with a 10-fold cross-validation were used to find the optimal partition of selected variables. The minimum number of cut-points (2, 3, or 4) was also tested by comparing the distributions of areas under receiver operating characteristic (AUROC) curves. Results Among the 1436 participants, 416 died within 28 days (28.9%). The sa-SOFA kept one variable per dimension and two cut-points per variable. The AUROC curves that investigated the abilities of the sa-SOFA and SOFA Scores to predict 28-day mortality were 0.739 [0.712–0.768] and 0.687 [0.656–0.717], respectively (p-value of DeLong test Conclusion Keeping the conventional SOFA dimension variables, the new sa-SOFA proved to be simpler and more accurate in predicting 28-day mortality.
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SOFA Score to assess the severity of the post cardiac arrest syndrome
Resuscitation, 2016Co-Authors: Martin Cour, Laurent Argaud, Didier Bresson, Romain HernuAbstract:Abstract Aim of the study The aim of the study was to assess the prognostic impact of organ failures at ICU admission after out-of-hospital cardiac arrest (CA) according to the SOFA Score. Methods We performed a retrospective analysis of a prospective cohort of all adult patients admitted to a 15-bed medical ICU in a university-affiliated hospital after an out-of-hospital CA. In addition to demographic and clinical data, initial illness severity was measured using the SOFA Score. Outcomes (mortality and neurological prognosis) were also collected at day 28 and one year. Results A total of 304 patients (age: 66±16 years, male: 55%) were admitted for post-CA management. An initial nonshockable cardiac rhythm was recorded in 274 (90%) cases. At admission, SOFA Score averaged 9.8±3.1 for the entire cohort (8.1±3.3 for day 28 survivors versus 10.1±3.1 for non-survivors, p p p =0.03). Conclusions In the present study, early organ failures, as assessed by the SOFA Score at ICU admission, were independently associated with day 28 mortality. SOFA Score may help clinicians objectively evaluate the severity of the post-CA syndrome.
Michael W Donnino - One of the best experts on this subject based on the ideXlab platform.
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use of SOFA Score in cardiac arrest research a scoping review
Resuscitation plus, 2020Co-Authors: Anne V Grossestreuer, Tuyen Yankama, Ari Moskowitz, Long Ngo, Michael W DonninoAbstract:Abstract Background The Sequential Organ Failure Assessment (SOFA) Score is a commonly used severity-of-illness Score in cardiac arrest research. Due to its nature, the SOFA Score often has missing data. How much data is missing and how that missing data is handled is unknown. Objectives We conducted a scoping review on cardiac arrest studies using SOFA, focusing on missing data. Data sources PubMed, Embase, and Web of Science. Study selection All English-language peer-reviewed studies of cardiac arrest with SOFA as an outcome or exposure were included. Data extraction For each study, quantity of missing SOFA data, analytic strategy to handle missing SOFA variables, whether/to what degree mortality influenced the amount of missing SOFA Scores), SOFA Score modifications, and number of SOFA measurements was extracted. Data synthesis We included 66 studies published between 2006–2019. Five studies were randomized controlled trials, 26 were prospective cohort studies, and 25 were retrospective cohort studies. SOFA was used as an outcome in 36 (55%) and a primary outcome in 10 (15%). Nine studies (14%) mentioned the quantity of missing SOFA data, which ranged from 0 to 76% (median: 10% [IQR: 6%, 42%]). Twenty-seven (41%) studies reported a method to handle missing SOFA. The most common method used excluded subjects with missing data (81%). In the 50 studies using serial SOFA Scores, 11 (22%) documented mortality prior to SOFA measurement; which ranged from 3% to 76% (median: 12% [IQR: 6%–35%]). Conclusions Missing data is common in cardiac arrest research using SOFA Scores. Variability exists in reporting and handling missing SOFA variables.
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abstract 316 missing data and the SOFA Score in cardiac arrest research a scoping review
Circulation, 2019Co-Authors: Anne V Grossestreuer, Tuyen Yankama, Ari Moskowitz, Long Ngo, Michael W DonninoAbstract:Introduction: The Sequential Organ Failure Assessment (SOFA) Score is often used as an outcome or exposure in cardiac arrest studies. SOFA requires lab values and vital signs at certain time points...