Khwannimit Bodin, Bhurayanontachai Rungsun, Vattanavanit Veerapong
Division of Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
Acute Crit Care. 2022 Aug;37(3):363-371. doi: 10.4266/acc.2021.01627. Epub 2022 Aug 4.
Some variables of the Sequential Organ Failure Assessment (SOFA) score are not routinely measured in sepsis patients, especially in countries with limited resources. Therefore, this study was conducted to evaluate the accuracy of the modified SOFA (mSOFA) and compared its ability to predict mortality in sepsis patients to that of the original SOFA score.
Sepsis patients admitted to the medical intensive care unit of Songklanagarind Hospital between 2011 and 2018 were retrospectively analyzed. The primary outcome was all-cause in-hospital mortality.
A total of 1,522 sepsis patients were enrolled. The mean SOFA and mSOFA scores were 9.7±4.3 and 8.8±3.9, respectively. The discrimination of the mSOFA score was significantly higher than that of the SOFA score for all-cause in-hospital mortality (area under the receiver operating characteristic curve, 0.891 [95% confidence interval, 0.875-0.907] vs. 0.879 [0.862-0.896]; P<0.001), all-cause intensive care unit (ICU) mortality (0.880 [0.863-0.898] vs. 0.871 [0.853-0.889], P=0.01) and all-cause 28-day mortality (0.887 [0.871-0.904] vs. 0.874 [0.856-0.892], P<0.001). The ability of mSOFA score to predict all-cause in-hospital and 28-day mortality was higher than that of the SOFA score within the subgroups of sepsis according to age, sepsis severity and serum lactate levels. The mSOFA score was demonstrated to have a performance similar to the original SOFA score regarding the prediction of mortality in sepsis patients with cirrhosis or hepatic dysfunction.
The mSOFA score was a good alternative to the original SOFA core in predicting mortality among sepsis patients admitted to the ICU.
序贯器官衰竭评估（SOFA）评分的一些变量在脓毒症患者中并非常规测量，尤其是在资源有限的国家。因此，本研究旨在评估改良SOFA（mSOFA）评分的准确性，并将其预测脓毒症患者死亡率的能力与原始SOFA评分进行比较。
对2011年至2018年期间宋卡王子大学医学院重症监护病房收治的脓毒症患者进行回顾性分析。主要结局是全因院内死亡率。
共纳入1522例脓毒症患者。SOFA评分和mSOFA评分的平均值分别为9.7±4.3和8.8±3.9。mSOFA评分对全因院内死亡率的判别能力显著高于SOFA评分（受试者工作特征曲线下面积，0.891[95%置信区间，0.875 - 0.907]对0.879[0.862 - 0.896]；P<0.001），全因重症监护病房（ICU）死亡率（0.880[0.863 - 0.898]对0.871[0.853 - 0.889]，P = 0.01）和全因28天死亡率（0.887[0.871 - 0.904]对0.874[0.856 - 0.892]，P<0.001）。在根据年龄、脓毒症严重程度和血清乳酸水平划分的脓毒症亚组中，mSOFA评分预测全因院内和28天死亡率的能力高于SOFA评分。在预测肝硬化或肝功能不全的脓毒症患者死亡率方面，mSOFA评分表现出与原始SOFA评分相似的性能。
在预测入住ICU的脓毒症患者死亡率方面，mSOFA评分是原始SOFA评分的良好替代指标。
