Evaluation of the SOFA score:: a single-center experience of a medical intensive care unit in 303 consecutive patients with predominantly cardiovascular disorders
Evaluation of the SOFA score:: a single-center experience of a medical intensive care unit in 303 consecutive patients with predominantly cardiovascular disorders
复制标题
DOI：
10.1007/s001340051316
复制
发表时间：
2000-08-01
影响因子：
38.9
通讯作者：
Hanrath, P
中科院分区：
文献类型：
--
作者：
Janssens, U;Graf, C;Hanrath, P
目的：评估序贯器官衰竭评估 (SOFA) 评分、总最大 SOFA (TMS) 评分和派生变量 Delta SOFA（TMS 评分减去第 1 天总 SOFA 评分）在医疗、心血管患者中的使用情况，作为描述器官功能障碍的发生率和严重程度以及有关结果的预后价值的方法。设计：前瞻性临床研究。地点：一所大学医院的医疗重症监护病房。患者：总共 303 名连续患者接受了治疗。包括（216 名男性，87 名女性；平均年龄 62 +/- 12.6 岁；SAPS II 26.2 +/- 12.7）。入院后 24 小时进行评估，此后每 24 小时进行一次评估，直至 1997 年 11 月至 1998 年 3 月期间出院或死亡。再次入院和 ICU 停留时间短于 12 小时的患者被排除在外。主要结局指标：出院时的生存状况、器官功能障碍/衰竭的发生率。干预措施：收集临床和人口数据以及原始数据，用于每 24 小时计算 SOFA 评分，直至出 ICU。测量和主要结果：ICU 住院时间为 3.7 +/- 4.7 天。 ICU 死亡率为 8.3%，住院死亡率为 14.5%。非幸存者在第 1 天和此后直至第 8 天的总 SOFA 得分较高（5.9 +/- 3.7 与 1.9 +/- 2.3，p < 0.001）。任何器官系统的高 SOFA 得分和器官衰竭数量的增加（SOFA 得分大于或等于 3）与死亡率增加相关。心血管和神经系统（第 1 天）与结局、心血管和呼吸系统以及从另一个 ICU 入院到 ICU 住院时间相关。非幸存者中的 TMS 评分较高（1.76 +/- 2.55 vs. 0.58 +/- 1.39，p < 0.01），并且第 1 天的 Delta SOFA/总 SOFA 与结果独立相关。第 1 天 TMS 的受试者工作特征曲线下面积为 0.86，SOFA 为 0.82，SAPS II 为 0.77。 结论：SOFA、TMS 和 Delta SOFA 评分为临床医生提供了有关内科、心血管患者器官功能障碍程度和进展的重要信息。第 1 天，SOFA 评分和 TMS 评分均比 SAPS II 评分具有更好的预后价值。该模型与结果密切相关，并识别出长期 ICU 住院风险增加的患者。
Objective: To evaluate the use of the Sequential Organ Failure Assessment (SOFA) score, the total maximum SOFA (TMS) score, and a derived variable, the Delta SOFA (TMS score minus total SOFA score on day 1) in medical, cardiovascular patients as a means for describing the incidence and severity of organ dysfunction and the prognostic value regarding outcome.Design: Prospective, clinical study.Setting: Medical intensive care unit in a university hospital.Patients: A total of 303 consecutive patients were included (216 men, 87 women; mean age 62 +/- 12.6 years; SAPS II 26.2 +/- 12.7). They were evaluated 24 h after admission and thereafter every 24 h until ICU discharge or death between November 1997 and March 1998. Readmissions and patients with an ICU stay shorter than 12 h were excluded.Main outcome measure: Survival status at hospital discharge, incidence of organ dysfunction/failure. Interventions: Collection of clinical and demographic data and raw data for the computation of the SOFA score every 24 h until ICU discharge.Measurements and main results: Length of ICU stay was 3.7 +/- 4.7 days. ICU mortality was 8.3 % and hospital mortality 14.5 %. Nonsurvivors had a higher total SOFA score on day 1 (5.9 +/- 3.7 vs. 1.9 +/- 2.3, p < 0.001) and thereafter until day 8. High SOFA scores for any organ system and increasing number of organ failures (SOFA score greater than or equal to 3) were associated with increased mortality. Cardiovascular and neurological systems (day 1) were related to outcome and cardiovascular and respiratory systems, and admission from another ICU to length of ICU stay. TMS score was higher in nonsurvivors (1.76 +/- 2.55 vs. 0.58 +/- 1.39, p < 0.01), and Delta SOFA/total SOFA on day 1 was independently related to outcome. The area under the receiver-operating characteristic curve was 0.86 for TMS, 0.82 for SOFA on day 1, and 0.77 for SAPS II.Conclusions: The SOFA, TMS, and Delta SOFA scores provide the clinician with important information on degree and progression of organ dysfunction in medical, cardiovascular patients. On day 1 both SOFA score and TMS score had a better prognostic value than SAPS II score. The model is closely related to outcome and identifies patients who are at increased risk for prolonged ICU stay.