Does the clinical frailty score improve the accuracy of the SOFA score in predicting hospital mortality in elderly critically ill patients? A prospective observational study.

PURPOSE

To determine whether the addition of the frailty status assessed by the clinical frailty scale (CFS) to the SOFA score (SOFA-CFS) improves the performance of the SOFA score alone in predicting the hospital mortality of elderly critically ill patients.

METHODS

A prospective observational study performed between February 2015 and February 2016 including 189 patients aged ≥65 years and hospitalized ≥24 h in the intensive care unit (ICU).

RESULTS

The SOFA-CFS score did not improve the performance of the SOFA score alone in predicting hospital mortality (AUC = 0.66, 95% CI 0.58-0.74 vs AUC = 0.63, 95% CI 0.55-0.72, respectively, p = 0.082). The AUC of the CFS score was 0.62 (95% CI 0.53-0.71). In the multivariable analysis, age (OR: 1.09, 95% CI 1.03-1.16, p = 0.006), McCabe score C vs A (reference) and B vs A (reference) (OR: 8.28, 95% CI 2.83-24.27and OR: 2.29, 95% CI 1.02-5.12, p = 0.006, respectively), Glasgow coma score at admission (OR: 0.31, 95% CI 0.14-0.48, p = 0.003), and SOFA score (OR: 1.11, 95% CI 1.01-1.23, p = 0.037) were risk factors for hospital mortality.

CONCLUSIONS

The performance of the SOFA score in predicting hospital mortality was low, although it was an independent risk factor for mortality. The combination of frailty status with the SOFA score did not improve the performance of the SOFA score alone.