Department of Medicine, Beth Israel Deaconess Medical Center - Boston (MA), United States.
Laboratory for Computational Physiology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology - Cambridge (MA), United States.
Crit Care Sci. 2024 Nov 22;36:e20240030en. doi: 10.62675/2965-2774.20240030-en. eCollection 2024.
Determine how each organ component of the SOFA score differs in its contribution to mortality risk and how that contribution may change over time.
We performed multivariate logistic regression analysis to assess the contribution of each organ component to mortality risk on Days 1 and 7 of an intensive care unit stay. We used data from two publicly available datasets, eICU Collaborative Research Database (eICU-CRD) (208 hospitals) and Medical Information Mart for Intensive Care IV (MIMIC-IV) (1 hospital). The odds ratio of each SOFA component that contributed to mortality was calculated. Mortality was defined as death either in the intensive care unit or within 72 hours of discharge from the intensive care unit.
A total of 7,871 intensive care unit stays from eICU-CRD and 4,926 intensive care unit stays from MIMIC-IV were included. Liver dysfunction was most predictive of mortality on Day 1 in both cohorts (OR 1.3; 95%CI 1.2 - 1.4; OR 1.3; 95%CI 1.2 - 1.4, respectively). In the eICU-CRD cohort, central nervous system dysfunction was most predictive of mortality on Day 7 (OR 1.4; 95%CI 1.4 - 1.5). In the MIMIC-IV cohort, respiratory dysfunction (OR 1.4; 95%CI 1.3 - 1.5) and cardiovascular dysfunction (OR 1.4; 95%CI 1.3 - 1.5) were most predictive of mortality on Day 7.
The SOFA score may be an oversimplification of how dysfunction of different organ systems contributes to mortality over time. Further research at a more granular timescale is needed to explore how the SOFA score can evolve and be ameliorated.
确定 SOFA 评分的每个器官组成部分在对死亡率风险的贡献方面有何不同，以及这种贡献如何随时间变化。
我们进行了多变量逻辑回归分析，以评估每个器官组成部分在入住重症监护病房第 1 天和第 7 天对死亡率风险的贡献。我们使用了两个公开可用数据集的数据，即 eICU 协作研究数据库 (eICU-CRD)（208 家医院）和重症监护医学信息集市 IV (MIMIC-IV)（1 家医院）。计算了对死亡率有贡献的每个 SOFA 成分的优势比。死亡率定义为在重症监护病房内死亡或从重症监护病房出院后 72 小时内死亡。
共纳入了来自 eICU-CRD 的 7871 例重症监护病房入住和来自 MIMIC-IV 的 4926 例重症监护病房入住。在两个队列中，肝功能障碍在第 1 天对死亡率的预测最准确（OR 1.3；95%CI 1.2-1.4；OR 1.3；95%CI 1.2-1.4）。在 eICU-CRD 队列中，中枢神经系统功能障碍在第 7 天对死亡率的预测最准确（OR 1.4；95%CI 1.4-1.5）。在 MIMIC-IV 队列中，呼吸功能障碍（OR 1.4；95%CI 1.3-1.5）和心血管功能障碍（OR 1.4；95%CI 1.3-1.5）在第 7 天对死亡率的预测最准确。
SOFA 评分可能过于简化了不同器官系统功能障碍随时间推移对死亡率的贡献。需要在更细粒度的时间尺度上进行进一步研究，以探讨 SOFA 评分如何演变和改善。
