Skip to main content
Erschienen in: Intensive Care Medicine 2/2005

01.02.2005 | Original

Use of the Sequential Organ Failure Assessment score as a severity score

verfasst von: André Carlos Kajdacsy-Balla Amaral, Fábio Moreira Andrade, Rui Moreno, Antonio Artigas, Francis Cantraine, Jean-Louis Vincent

Erschienen in: Intensive Care Medicine | Ausgabe 2/2005

Einloggen, um Zugang zu erhalten

Abstract

Objective

To evaluate whether the SOFA score can be used to develop a model to predict intensive care unit (ICU) mortality in different countries.

Design and setting

Analysis of a prospectively collected database. Patients with ICU stay longer than 2 days were studied to develop a mortality prediction model based on measurements of organ dysfunction.

Patients

748 patients from six countries.

Measurements and results

Two logistic regression models were constructed, one based on the SOFA maximum (SOFA Max model) and the other on variables identified by multivariate regression (SOFA Max-infection model). The H and C statistics had a p value above 0.05 for both models, but the D statistics showed a poor performance on the SOFA Max model when stratified for the presence of infection. Subsequent analysis was performed with SOFA Max-infection model. The area under the curve was 0.853. There were no statistically significant differences in observed and predicted mortalities except for one country which had a higher than predicted ICU mortality both in the overall population (28.3 vs. 19.1%) and in the noninfected patients (21.4 vs. 12.6%).

Conclusions

The SOFA Max adjusted for age and the presence of infection can predict mortality in this population, but in one country the ICU mortality was higher than expected. Our data do not allow us to determine the reasons behind these differences, and further studies to detect differences in mortality between countries and to elucidate the basis for these differences should be encouraged.
Literatur
1.
Zurück zum Zitat Shortell SM, Zimmerman JE, Rousseau DM, Gillies RR, Wagner DP, Draper EA, Knaus WA, Duffy J (1994) The performance of intensive care units: does good management make a difference? Med Care 32:508–525 Shortell SM, Zimmerman JE, Rousseau DM, Gillies RR, Wagner DP, Draper EA, Knaus WA, Duffy J (1994) The performance of intensive care units: does good management make a difference? Med Care 32:508–525
2.
Zurück zum Zitat Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMed Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMed
3.
Zurück zum Zitat Le Gall J-R, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963PubMed Le Gall J-R, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963PubMed
4.
Zurück zum Zitat Lemeshow S, Teres D, Avrunin JS, Gage RW (1988) Refining intensive care unit outcome prediction by using changing probabilities of mortality. Crit Care Med 16:470–477 Lemeshow S, Teres D, Avrunin JS, Gage RW (1988) Refining intensive care unit outcome prediction by using changing probabilities of mortality. Crit Care Med 16:470–477
5.
Zurück zum Zitat Chang RWS, Jacobs S, Lee B (1988) Predicting outcome among intensive care unit patients using computerized trend analysis of daily APACHE II scores corrected for organ system failure. Intensive Care Med 14:558–566 Chang RWS, Jacobs S, Lee B (1988) Predicting outcome among intensive care unit patients using computerized trend analysis of daily APACHE II scores corrected for organ system failure. Intensive Care Med 14:558–566
6.
Zurück zum Zitat Rogers J, Fuller HD (1994) Use of daily Acute Physiology and Chronic Health Evaluation (APACHE) II scores to predict individual patient survival rate. Crit Care Med 22:1402–1405 Rogers J, Fuller HD (1994) Use of daily Acute Physiology and Chronic Health Evaluation (APACHE) II scores to predict individual patient survival rate. Crit Care Med 22:1402–1405
7.
Zurück zum Zitat Rué M, Quintana S, Alvarez M, Artigas A (2001) Daily assessment of severity of illness and mortality prediction for individual patients. Crit Care Med 29:45–50 Rué M, Quintana S, Alvarez M, Artigas A (2001) Daily assessment of severity of illness and mortality prediction for individual patients. Crit Care Med 29:45–50
8.
Zurück zum Zitat Sicignano A, Carozzi C, Giudici D, Merli G, Arlati S, Pulici M, on behalf of ARCHIDIA (1996) The influence of length of stay in the ICU on power of discrimination of a multipurpose severity score (SAPS). Intensive Care Med 22:1048–1051 Sicignano A, Carozzi C, Giudici D, Merli G, Arlati S, Pulici M, on behalf of ARCHIDIA (1996) The influence of length of stay in the ICU on power of discrimination of a multipurpose severity score (SAPS). Intensive Care Med 22:1048–1051
9.
Zurück zum Zitat Wong DT, Crofts SL, Gomez M, McGuire GP, Byrick RJ (1995) Evaluation of predictive ability of APACHE II system and hospital outcome in Canadian intensive care unit patients. Crit Care Med 23:1177–1183CrossRef Wong DT, Crofts SL, Gomez M, McGuire GP, Byrick RJ (1995) Evaluation of predictive ability of APACHE II system and hospital outcome in Canadian intensive care unit patients. Crit Care Med 23:1177–1183CrossRef
10.
Zurück zum Zitat Castella X, Artigas A, Bion J, Kari A (1995) A comparison of severity of illness scoring systems for intensive care unit patients: results of a multicenter, multinational study. The European/North American Severity Study Group. Crit Care Med 23:1327–1335CrossRef Castella X, Artigas A, Bion J, Kari A (1995) A comparison of severity of illness scoring systems for intensive care unit patients: results of a multicenter, multinational study. The European/North American Severity Study Group. Crit Care Med 23:1327–1335CrossRef
11.
Zurück zum Zitat Rowan KM, Kerr JH, Major E, McPherson K, Short A, Vessey MP (1994) Intensive Care Society’s Acute Physiology and Chronic Health Evaluation (APACHE II) study in Britain and Ireland: a prospective, multicenter, cohort study comparing two methods for predicting outcome for adult intensive care patients. Crit Care Med 22:1392–1401 Rowan KM, Kerr JH, Major E, McPherson K, Short A, Vessey MP (1994) Intensive Care Society’s Acute Physiology and Chronic Health Evaluation (APACHE II) study in Britain and Ireland: a prospective, multicenter, cohort study comparing two methods for predicting outcome for adult intensive care patients. Crit Care Med 22:1392–1401
12.
Zurück zum Zitat Clermont G, Angus DC, DiRusso SM, Griffin M, Linde-Zwirble WT (2001) Predicting hospital mortality for patients in the intensive care unit: a comparison of artificial neural networks with logistic regression models. Crit Care Med 29:291–296CrossRef Clermont G, Angus DC, DiRusso SM, Griffin M, Linde-Zwirble WT (2001) Predicting hospital mortality for patients in the intensive care unit: a comparison of artificial neural networks with logistic regression models. Crit Care Med 29:291–296CrossRef
13.
Zurück zum Zitat Murphy-Filkins R, Teres D, Lemeshow S, Hosmer DW (1996) Effect of changing patient mix on the performance of an intensive care unit severity-of-illness model: how to distinguish a general from a specialty intensive care unit. Crit Care Med 24:1968–1973CrossRef Murphy-Filkins R, Teres D, Lemeshow S, Hosmer DW (1996) Effect of changing patient mix on the performance of an intensive care unit severity-of-illness model: how to distinguish a general from a specialty intensive care unit. Crit Care Med 24:1968–1973CrossRef
14.
Zurück zum Zitat Goldhill DR, Withington PS (1996) The effect of casemix adjustment on mortality as predicted by APACHE II. Intensive Care Med 22:415–419 Goldhill DR, Withington PS (1996) The effect of casemix adjustment on mortality as predicted by APACHE II. Intensive Care Med 22:415–419
15.
Zurück zum Zitat Patel PA, Grant BJ (1999) Application of mortality prediction systems to individual intensive care units. Intensive Care Med 25:977–982 Patel PA, Grant BJ (1999) Application of mortality prediction systems to individual intensive care units. Intensive Care Med 25:977–982
16.
Zurück zum Zitat Vincent JL, Moreno R, Takala J, Willatts S, de Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-Related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 22:707–710CrossRefPubMed Vincent JL, Moreno R, Takala J, Willatts S, de Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-Related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 22:707–710CrossRefPubMed
17.
Zurück zum Zitat Tran DD, Groeneveld ABJ, Vander Meulen J, Nauta JJP, Strack Van Schijndel RJM, Thijs LG (1990) Age, chronic disease, sepsis, organ system failure, and mortality in a medical intensive care unit. Crit Care Med 18:474–479 Tran DD, Groeneveld ABJ, Vander Meulen J, Nauta JJP, Strack Van Schijndel RJM, Thijs LG (1990) Age, chronic disease, sepsis, organ system failure, and mortality in a medical intensive care unit. Crit Care Med 18:474–479
18.
Zurück zum Zitat Deitch EA (1992) Multiple organ failure: pathophysiology and potential future therapy. Ann Surg 216:117–134PubMed Deitch EA (1992) Multiple organ failure: pathophysiology and potential future therapy. Ann Surg 216:117–134PubMed
19.
Zurück zum Zitat Moreno R, Vincent JL, Matos A, de Mendonça A, Cantraine F, Thijs J, Takala J, Sprung C, Antonelli M, Bruining H, Willatts S (1999) The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Intensive Care Med 25:686–696CrossRefPubMed Moreno R, Vincent JL, Matos A, de Mendonça A, Cantraine F, Thijs J, Takala J, Sprung C, Antonelli M, Bruining H, Willatts S (1999) The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Intensive Care Med 25:686–696CrossRefPubMed
20.
Zurück zum Zitat Lopes Ferreira F, Peres Bota D, Bross A, Melot C, Vincent JL (2001) Serial evaluation of the SOFA score to predict outcome. JAMA 286:1754–1758CrossRefPubMed Lopes Ferreira F, Peres Bota D, Bross A, Melot C, Vincent JL (2001) Serial evaluation of the SOFA score to predict outcome. JAMA 286:1754–1758CrossRefPubMed
21.
Zurück zum Zitat Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter P, Sprung C, Colardyn FC, Blecher S (1998) Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicentric, prospective study. Crit Care Med 26:1793–1800PubMed Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter P, Sprung C, Colardyn FC, Blecher S (1998) Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicentric, prospective study. Crit Care Med 26:1793–1800PubMed
22.
Zurück zum Zitat Lemeshow S, Hosmer DWJ (1982) A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol 115:92–106 Lemeshow S, Hosmer DWJ (1982) A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol 115:92–106
23.
Zurück zum Zitat Pulkstenis E, Robinson TJ (2002) Two goodness-of-fit tests for logistic regression models with continuous covariates. Stat Med 21:79–93CrossRef Pulkstenis E, Robinson TJ (2002) Two goodness-of-fit tests for logistic regression models with continuous covariates. Stat Med 21:79–93CrossRef
24.
Zurück zum Zitat Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36PubMed Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36PubMed
25.
Zurück zum Zitat Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148:839–843PubMed Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148:839–843PubMed
26.
Zurück zum Zitat Tilney NL, Bailey GL, Morgan AP (1973) Sequential system failure after rupture of abdominal aortic aneurysms: an unsolved problem in postoperative care. Ann Surg 178:117–122 Tilney NL, Bailey GL, Morgan AP (1973) Sequential system failure after rupture of abdominal aortic aneurysms: an unsolved problem in postoperative care. Ann Surg 178:117–122
27.
Zurück zum Zitat Fry DE, Pearlstein L, Fulton RL, Hiram CP (1980) Multiple system organ failure: the role of uncontrolled infection. Arch Surg 115:136–140 Fry DE, Pearlstein L, Fulton RL, Hiram CP (1980) Multiple system organ failure: the role of uncontrolled infection. Arch Surg 115:136–140
28.
Zurück zum Zitat Bell RC, Coalson JJ, Smith JD et al (1983) Multiple organ system failure and infection in adult respiratory distress syndrome. Ann Intern Med 99:293–298 Bell RC, Coalson JJ, Smith JD et al (1983) Multiple organ system failure and infection in adult respiratory distress syndrome. Ann Intern Med 99:293–298
29.
Zurück zum Zitat Tran DD, Cuesta MA (1992) Evaluation of severity in patients with acute pancreatitis. Am J Gastroenterol 87:604–608 Tran DD, Cuesta MA (1992) Evaluation of severity in patients with acute pancreatitis. Am J Gastroenterol 87:604–608
30.
Zurück zum Zitat Marshall WG Jr, Dimick AR (1983) The natural history of major burns with multiple subsystem failure. J Trauma 23:102–105 Marshall WG Jr, Dimick AR (1983) The natural history of major burns with multiple subsystem failure. J Trauma 23:102–105
31.
Zurück zum Zitat Henao FJ, Daes JE, Dennis RJ (1991) Risk factors for multiorgan failure: a case-control study. J Trauma 31:74–80 Henao FJ, Daes JE, Dennis RJ (1991) Risk factors for multiorgan failure: a case-control study. J Trauma 31:74–80
32.
Zurück zum Zitat Faist E, Baue A, Ditmer H, Heberer G (1983) Multiple organ failure in polytrauma patients. J Trauma 23:775–787 Faist E, Baue A, Ditmer H, Heberer G (1983) Multiple organ failure in polytrauma patients. J Trauma 23:775–787
33.
Zurück zum Zitat Antonelli M, Moreno R, Vincent JL, Sprung CL, Mendoca A, Passariello M, Riccioni L, Osborn J (1999) Application of SOFA score to trauma patients. Sequential Organ Failure Assessment. Intensive Care Med 25:389–394 Antonelli M, Moreno R, Vincent JL, Sprung CL, Mendoca A, Passariello M, Riccioni L, Osborn J (1999) Application of SOFA score to trauma patients. Sequential Organ Failure Assessment. Intensive Care Med 25:389–394
34.
Zurück zum Zitat Bossink AW, Groeneveld J, Hack CE, Thijs LG (1998) Prediction of mortality in febrile medical patients: how useful are systemic inflammatory response syndrome and sepsis criteria? Chest 113:1533–1541 Bossink AW, Groeneveld J, Hack CE, Thijs LG (1998) Prediction of mortality in febrile medical patients: how useful are systemic inflammatory response syndrome and sepsis criteria? Chest 113:1533–1541
35.
Zurück zum Zitat Moreno R, Morais P (1997) Outcome prediction in intensive care: results of a prospective, multicentre, Portuguese study. Intensive Care Med 23:177–186 Moreno R, Morais P (1997) Outcome prediction in intensive care: results of a prospective, multicentre, Portuguese study. Intensive Care Med 23:177–186
36.
Zurück zum Zitat Sirio CA, Tajimi K, Tase C (1992) An initial comparison of intensive care in Japan and the United States. Crit Care Med 20:1207–1215 Sirio CA, Tajimi K, Tase C (1992) An initial comparison of intensive care in Japan and the United States. Crit Care Med 20:1207–1215
37.
Zurück zum Zitat Rivera-Fernandez R, Vazquez-Mata G, Bravo M, Aguayo-Hoyos E, Zimmerman J, Wagner D, Knaus W (1998) The Apache III prognostic system: customized mortality predictions for Spanish ICU patients. Intensive Care Med 24:574–581 Rivera-Fernandez R, Vazquez-Mata G, Bravo M, Aguayo-Hoyos E, Zimmerman J, Wagner D, Knaus W (1998) The Apache III prognostic system: customized mortality predictions for Spanish ICU patients. Intensive Care Med 24:574–581
38.
Zurück zum Zitat Markgraf R, Deutschinoff G, Pientka L, Scholten T, Lorenz C (2001) Performance of the score systems Acute Physiology and Chronic Health Evaluation II and III at an interdisciplinary intensive care unit, after customization. Crit Care 5:31–36CrossRef Markgraf R, Deutschinoff G, Pientka L, Scholten T, Lorenz C (2001) Performance of the score systems Acute Physiology and Chronic Health Evaluation II and III at an interdisciplinary intensive care unit, after customization. Crit Care 5:31–36CrossRef
39.
Zurück zum Zitat Metnitz PG, Lang T, Valentin A, Steltzer H, Krenn CG, Le Gall JR (2001) Evaluation of the logistic organ dysfunction system for the assessment of organ dysfunction and mortality in critically ill patients. Intensive Care Med 27:992–998 Metnitz PG, Lang T, Valentin A, Steltzer H, Krenn CG, Le Gall JR (2001) Evaluation of the logistic organ dysfunction system for the assessment of organ dysfunction and mortality in critically ill patients. Intensive Care Med 27:992–998
40.
Zurück zum Zitat Bastos PG, Knaus WA, Zimmerman JE, Magalhaes M, Sun X, Wagner DP, The Brazil APACHE III Study Group (1996) The importance of technology for achieving superior outcomes from intensive care. Intensive Care Med 22:664–669 Bastos PG, Knaus WA, Zimmerman JE, Magalhaes M, Sun X, Wagner DP, The Brazil APACHE III Study Group (1996) The importance of technology for achieving superior outcomes from intensive care. Intensive Care Med 22:664–669
41.
Zurück zum Zitat Apolone G, Bertolini G, D’Amico R, Iapichino G, Cattaneo A, De Salvo G, Melotti RM (1996) The performance of SAPS II in a cohort of patients admitted to 99 Italian ICUs: results from GiViTI. Gruppo Italiano per la Valutazione degli interventi in Terapia Intensiva. Intensive Care Med 22:1368–1378 Apolone G, Bertolini G, D’Amico R, Iapichino G, Cattaneo A, De Salvo G, Melotti RM (1996) The performance of SAPS II in a cohort of patients admitted to 99 Italian ICUs: results from GiViTI. Gruppo Italiano per la Valutazione degli interventi in Terapia Intensiva. Intensive Care Med 22:1368–1378
42.
Zurück zum Zitat Beck DH, Taylor BL, Millar B, Smith GB (1997) Prediction of outcome from intensive care: a prospective cohort study comparing Acute Physiology and Chronic Health Evaluation II and III prognostic systems in a United Kingdom intensive care unit. Crit Care Med 25:9–15CrossRef Beck DH, Taylor BL, Millar B, Smith GB (1997) Prediction of outcome from intensive care: a prospective cohort study comparing Acute Physiology and Chronic Health Evaluation II and III prognostic systems in a United Kingdom intensive care unit. Crit Care Med 25:9–15CrossRef
43.
Zurück zum Zitat Teres D, Lemeshow S (1999) When to customize a severity model. Intensive Care Med 25:140–142 Teres D, Lemeshow S (1999) When to customize a severity model. Intensive Care Med 25:140–142
44.
Zurück zum Zitat Ghuysen A, Lambermont B, D’Orio V (2000) [Application of the Simplified Acute Physiology Score II (SAPS II) in a medical intensive care unit]. Ann Fr Anesth Reanim 19:510–516CrossRef Ghuysen A, Lambermont B, D’Orio V (2000) [Application of the Simplified Acute Physiology Score II (SAPS II) in a medical intensive care unit]. Ann Fr Anesth Reanim 19:510–516CrossRef
45.
Zurück zum Zitat Buist M, Gould T, Hagley S, Webb R (2000) An analysis of excess mortality not predicted to occur by APACHE III in an Australian level III intensive care unit. Anaesth Intensive Care 28:171–177 Buist M, Gould T, Hagley S, Webb R (2000) An analysis of excess mortality not predicted to occur by APACHE III in an Australian level III intensive care unit. Anaesth Intensive Care 28:171–177
Metadaten
Titel
Use of the Sequential Organ Failure Assessment score as a severity score
verfasst von
André Carlos Kajdacsy-Balla Amaral
Fábio Moreira Andrade
Rui Moreno
Antonio Artigas
Francis Cantraine
Jean-Louis Vincent
Publikationsdatum
01.02.2005
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 2/2005
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-004-2528-6

Weitere Artikel der Ausgabe 2/2005

Intensive Care Medicine 2/2005 Zur Ausgabe

Announcements

February 2005

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

17.05.2024 Klinik aktuell Nachrichten

Sie sei „ethisch geboten“, meint Gesundheitsminister Karl Lauterbach: mehr Transparenz über die Qualität von Klinikbehandlungen. Um sie abzubilden, lässt er gegen den Widerstand vieler Länder einen virtuellen Klinik-Atlas freischalten.

Delir bei kritisch Kranken – Antipsychotika versus Placebo

16.05.2024 Delir Nachrichten

Um die Langzeitfolgen eines Delirs bei kritisch Kranken zu mildern, wird vielerorts auf eine Akuttherapie mit Antipsychotika gesetzt. Eine US-amerikanische Forschungsgruppe äußert jetzt erhebliche Vorbehalte gegen dieses Vorgehen. Denn es gibt neue Daten zum Langzeiteffekt von Haloperidol bzw. Ziprasidon versus Placebo.

Klinikreform soll zehntausende Menschenleben retten

15.05.2024 Klinik aktuell Nachrichten

Gesundheitsminister Lauterbach hat die vom Bundeskabinett beschlossene Klinikreform verteidigt. Kritik an den Plänen kommt vom Marburger Bund. Und in den Ländern wird über den Gang zum Vermittlungsausschuss spekuliert.

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.