Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland.
University of Eastern Finland, Kuopio, Finland.
Acta Anaesthesiol Scand. 2022 Jul;66(6):731-741. doi: 10.1111/aas.14067. Epub 2022 Apr 10.
Sequential Organ Failure Assessment (SOFA) is a practical method to describe and quantify the presence and severity of organ system dysfunctions and failures. Some proposals suggest that SOFA could be employed as an endpoint in trials. To justify this, all SOFA component scores should reflect organ dysfunctions of comparable severity. We aimed to investigate whether the associations of different SOFA components with in-hospital mortality are comparable.
We performed a study based on nationwide register data on adult patients admitted to 26 Finnish intensive care units (ICUs) during 2012-2015. We determined the SOFA score as the maximum score in the first 24 hours after ICU admission. We defined organ failure (OF) as an organ-specific SOFA score of three or higher. We evaluated the association of different SOFA component scores with mortality.
Our study population comprised 63,756 ICU patients. Overall hospital mortality was 10.7%. In-hospital mortality was 22.5% for patients with respiratory failure, 34.8% for those with coagulation failure, 40.1% for those with hepatic failure, 14.9% for those with cardiovascular failure, 26.9% for those with neurologic failure and 34.6% for the patients with renal failure. Among patients with comparable total SOFA scores, the risk of death was lower in patients with cardiovascular OF compared with patients with other OFs.
All SOFA components are associated with mortality, but their weights are not comparable. High scores of other organ systems mean a higher risk of death than high cardiovascular scores. The scoring of cardiovascular dysfunction needs to be updated.
序贯器官衰竭评估（SOFA）是一种描述和量化器官系统功能障碍和衰竭的存在和严重程度的实用方法。一些建议表明，SOFA 可以作为试验的终点。为了证明这一点，所有 SOFA 组成部分的评分都应反映出具有相当严重程度的器官功能障碍。我们旨在研究不同 SOFA 成分与住院死亡率的相关性是否具有可比性。
我们进行了一项基于 2012 年至 2015 年期间在芬兰 26 个重症监护病房（ICU）住院的成年患者的全国性登记数据的研究。我们将 ICU 入住后 24 小时内的最大 SOFA 评分确定为 SOFA 评分。我们将器官衰竭（OF）定义为特定器官的 SOFA 评分为 3 或更高。我们评估了不同 SOFA 成分评分与死亡率的相关性。
我们的研究人群包括 63756 名 ICU 患者。总住院死亡率为 10.7%。呼吸衰竭患者的院内死亡率为 22.5%，凝血功能衰竭患者为 34.8%，肝功能衰竭患者为 40.1%，心血管功能衰竭患者为 14.9%，神经功能衰竭患者为 26.9%，肾功能衰竭患者为 34.6%。在具有可比总 SOFA 评分的患者中，与其他 OF 患者相比，心血管 OF 患者的死亡风险较低。
所有 SOFA 成分都与死亡率相关，但它们的权重并不具有可比性。其他器官系统的高评分意味着死亡风险高于心血管系统的高评分。心血管功能障碍的评分需要更新。
