Departments of Intensive Care Medicine.
Statistics and Clinical Investigation, University Hospital 12 de Octubre, Madrid, Spain.
Eur J Emerg Med. 2018 Dec;25(6):387-393. doi: 10.1097/MEJ.0000000000000472.
The condition of critically ill patients in the emergency department (ED) varies from moment to moment. The aims of this study are to quantify sequential organ failure assessment (SOFA) and changes in SOFA scores over time and determine its prognostic impact.
This is a prospective observational cohort study. We included 269 patients consecutively admitted to the ICU from the ED over 18 months. The SOFA scores at ED admission (ED-SOFA) and ICU admission (ICU-SOFA) were obtained. Relative changes in SOFA scores were calculated as follows: Δ-SOFA=ICU-SOFA-ED-SOFA. Patients were divided into two groups depending on the Δ-SOFA score: (a) Δ-SOFA=0-1; and (b) Δ-SOFA more than or equal to 2.
The median ED-SOFA score was two points (interquartile range: 1-4.5) and the Δ-SOFA score was 2 points (interquartile range: 0-3). The Δ-SOFA score was more powerful (area under the curve: 0.81) than the ED-SOFA score (area under the curve: 0.75) in predicting hospital mortality. Sixteen (6%) patients had a Δ-SOFA score less than 0, 116 (43%) patients had a Δ-SOFA=0-1, and 137 (51%) patients had a Δ-SOFA of at least 2 points. The probability of being alive at hospital discharge was 51 and 86.5% in Δ-SOFA of at least 2 and Δ-SOFA=0-1 groups, respectively (P<0.001). Risk factors for an increase of two or more SOFA points were age, cirrhosis, a diagnosis of sepsis, and a prolonged ED stay.
SOFA and changes in the SOFA score over time are potentially useful tools for risk stratification when applied to critically ill patients admitted to ICUs from the ED.
急诊部（ED）危重症患者的病情瞬息万变。本研究旨在量化序贯器官衰竭评估（SOFA）和 SOFA 评分随时间的变化，并确定其预后影响。
这是一项前瞻性观察队列研究。我们纳入了 18 个月内在 ICU 连续收治的 269 名来自 ED 的患者。获得 ED 入院时（ED-SOFA）和 ICU 入院时（ICU-SOFA）的 SOFA 评分。SOFA 评分的相对变化如下计算：Δ-SOFA=ICU-SOFA-ED-SOFA。根据 Δ-SOFA 评分，患者分为两组：（a）Δ-SOFA=0-1；（b）Δ-SOFA 大于或等于 2。
ED-SOFA 评分中位数为 2 分（四分位间距：1-4.5），Δ-SOFA 评分为 2 分（四分位间距：0-3）。Δ-SOFA 评分（曲线下面积：0.81）比 ED-SOFA 评分（曲线下面积：0.75）更能预测住院死亡率。16 名（6%）患者的 Δ-SOFA 评分小于 0，116 名（43%）患者的 Δ-SOFA=0-1，137 名（51%）患者的 Δ-SOFA 评分至少为 2 分。Δ-SOFA 评分至少为 2 分和 Δ-SOFA=0-1 组患者出院时存活的概率分别为 51%和 86.5%（P<0.001）。SOFA 评分增加 2 分或以上的危险因素包括年龄、肝硬化、败血症诊断和 ED 停留时间延长。
SOFA 评分及其随时间的变化是 ICU 从 ED 收治的危重症患者进行风险分层的潜在有用工具。
