Janssens U, Graf C, Graf J, Radke P W, Königs B, Koch K C, Lepper W, vom Dahl J, Hanrath P
Medical Clinic I, University Hospital of Aachen, Germany.
Intensive Care Med. 2000 Aug;26(8):1037-45. doi: 10.1007/s001340051316.
To evaluate the use of the Sequential Organ Failure Assessment (SOFA) score, the total maximum SOFA (TMS) score, and a derived variable, the deltaSOFA (TMS score minus total SOFA score on day 1) in medical, cardiovascular patients as a means for describing the incidence and severity of organ dysfunction and the prognostic value regarding outcome.
Prospective, clinical study.
Medical intensive care unit in a university hospital.
A total of 303 consecutive patients were included (216 men, 87 women; mean age 62 +/- 12.6 years; SAPS II 26.2 +/- 12.7). They were evaluated 24 h after admission and thereafter every 24 h until ICU discharge or death between November 1997 and March 1998. Readmissions and patients with an ICU stay shorter than 12 h were excluded.
Survival status at hospital discharge, incidence of organ dysfunction/failure.
Collection of clinical and demographic data and raw data for the computation of the SOFA score every 24 h until ICU discharge.
Length of ICU stay was 3.7 +/- 4.7 days. ICU mortality was 8.3% and hospital mortality 14.5%. Nonsurvivors had a higher total SOFA score on day 1 (5.9 +/- 3.7 vs. 1.9 +/- 2.3, p < 0.001) and thereafter until day 8. High SOFA scores for any organ system and increasing number of organ failures (SOFA score > or = 3) were associated with increased mortality. Cardiovascular and neurological systems (day 1) were related to outcome and cardiovascular and respiratory systems, and admission from another ICU to length of ICU stay. TMS score was higher in nonsurvivors (1.76 +/- 2.55 vs. 0.58 +/- 1.39, p < 0.01), and deltaSOFA/total SOFA on day 1 was independently related to outcome. The area under the receiver-operating characteristic curve was 0.86 for TMS, 0.82 for SOFA on day 1, and 0.77 for SAPS II.
The SOFA, TMS, and deltaSOFA scores provide the clinician with important information on degree and progression of organ dysfunction in medical, 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.
评估序贯器官衰竭评估（SOFA）评分、总最大SOFA（TMS）评分以及一个衍生变量deltaSOFA（TMS评分减去第1天的总SOFA评分）在医疗、心血管疾病患者中用于描述器官功能障碍的发生率和严重程度以及对预后价值的情况。
前瞻性临床研究。
大学医院的医疗重症监护病房。
共纳入303例连续患者（216例男性，87例女性；平均年龄62±12.6岁；简化急性生理学评分II [SAPS II]为26.2±12.7）。在1997年11月至1998年3月期间，患者入院24小时后进行评估，此后每24小时评估一次，直至重症监护病房（ICU）出院或死亡。再次入院患者以及ICU住院时间短于12小时的患者被排除。
出院时的生存状况；器官功能障碍/衰竭的发生率。
收集临床和人口统计学数据以及每24小时计算SOFA评分的原始数据，直至ICU出院。
ICU住院时间为3.7±4.7天。ICU死亡率为8.3%，医院死亡率为14.5%。非幸存者在第1天的总SOFA评分更高（5.9±3.7对1.9±2.3，p<0.001），此后直至第8天也是如此。任何器官系统的高SOFA评分以及器官衰竭数量增加（SOFA评分≥3）与死亡率增加相关。心血管和神经系统（第1天）与预后相关，心血管和呼吸系统以及从另一个ICU转入与ICU住院时间相关。非幸存者的TMS评分更高（-1.76±2.55对-0.58±1.39，p<0.01），且第1天的deltaSOFA/总SOFA与预后独立相关。TMS的受试者工作特征曲线下面积为0.86，第1天SOFA的为0.82，SAPS II的为0.77。
SOFA、TMS和deltaSOFA评分可为临床医生提供有关医疗、心血管疾病患者器官功能障碍程度和进展的重要信息。在第1天，SOFA评分和TMS评分的预后价值均优于SAPS II评分。该模型与预后密切相关，并能识别出ICU住院时间延长风险增加的患者。
