Serial evaluation of the SOFA score to predict outcome in critically ill patients
Serial evaluation of the SOFA score to predict outcome in critically ill patients
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DOI：
10.1001/jama.286.14.1754
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发表时间：
2001-10-10
影响因子：
120.7
通讯作者：
Vincent, JL
中科院分区：
文献类型：
--
作者：
Ferreira, FL;Bota, DP;Vincent, JL
目的探讨重症监护病房（ICU）患者器官功能障碍的趋势评估对预后的预测价值，并探讨序贯器官功能衰竭评估（SOFA）评分对ICU患者死亡率的预测价值。1999年，地点：比利时一所大学医院的31张内科外科ICU。（平均年龄，59岁）入住ICU超过24小时的患者在入院时和出院前每48小时计算一次SOFA评分。主要结果指标初始SOFA评分（0-24）、Delta-SOFA评分（后续评分之间的差异）、ICU住院期间获得的最高和平均SOFA评分及其与死亡率的相关性。初始和最高评分超过11或平均评分超过5对应于死亡率超过80%。平均评分的预测价值与ICU住院时间无关。在单变量分析中，平均和最高SOFA评分与死亡率的相关性最强，其次是Delta-SOFA和初始SOFA评分。受试者工作特征曲线下面积最大，得分最高（0.90; SE，0.02; P90%），前48小时内评分下降与死亡率低于6%相关，而当初始评分为2 - 7时，评分不变或增加与37%的死亡率相关，而当初始评分为60%时，结论在ICU入院的最初几天进行器官功能不全的序贯评估是一个很好的预后指标。平均和最高SOFA评分都是特别有用的结局预测因子。独立于初始评分，在ICU的前48小时内SOFA评分的增加预测死亡率至少为50%。
Context Evaluation of trends in organ dysfunction in critically ill patients may help predict outcome.Objective To determine the usefulness of repeated measurement the Sequential Organ Failure Assessment (SOFA) score for prediction of mortality in intensive care unit (ICU) patients.Design Prospective, observational cohort study conducted from April 1 to July 31, 1999.Setting A 31-bed medicosurgical ICU at a university hospital in Belgium.Patients Three hundred fifty-two consecutive patients (mean age, 59 years) admitted to the ICU for more than 24 hours for whom the SOFA score was calculated on admission and every 48 hours until discharge.Main Outcome Measures Initial SOFA score (0-24), Delta -SOFA scores (differences between subsequent scores), and the highest and mean SOFA scores obtained during the ICU stay and their correlations with mortality.Results The initial, highest, and mean SOFA scores correlated well with mortality. Initial and highest scores of more than 11 or mean scores of more than 5 corresponded to mortality of more than 80%. The predictive value of the mean score was independent of the length of ICU stay. In univariate analysis, mean and highest SOFA scores had the strongest correlation with mortality, followed by Delta-SOFA and initial SOFA scores. The area under the receiver operating characteristic curve was largest for highest scores (0.90; SE, 0.02; P90%), a decreasing score during the first 48 hours was associated with a mortality rate of less than 6%, while an unchanged or increasing score was associated with a mortality rate of 37% when the initial score was 2 to 7 and 60% when the initial score was 8 to 11.Conclusions Sequential assessment of organ dysfunction during the first few days of ICU admission is a good indicator of prognosis. Both the mean and highest SOFA scores are particularly useful predictors of outcome. Independent of the initial score, an increase in SOFA score during the first 48 hours in the ICU predicts a mortality rate of at least 50%.