Background: Multiple organ dysfunction syndrome (MODS) is an important cause of morbidity and mortality in the Intensive Care Unit (ICU). Sequential Organ Failure Assessment (SOFA) scores, determined upon ICU admission, can identify patients at risk of unfavorable outcomes and trigger assessment and application of interventional approaches, of which effectiveness can be evaluated by determining the SOFA score trend after 48 hours. Herein, we evaluated the impact of an admission SOFA score ≥ 2 and the 48-hour delta SOFA, on critically ill patients’ outcomes.
Methods: This retrospective, observational cohort study included 1101 patients admitted to three ICUs of a tertiary hospital, from January 01 to December 31, 2020. SOFA scores—determined upon ICU admission and 48 hours thereafter—denoted three patient groups: those with admission SOFA scores below 2 (Group 1, n = 348), those with admission SOFA scores ≥ 2 whose 48-hour delta SOFA reflected improvement (SOFA after 48 hours < admission SOFA) (Group 2, n = 415), and those with admission SOFA scores ≥ 2 that had increased or remained unchanged after 48 hours (SOFA after 48 hours ≥ admission SOFA) (Group 3, n = 338). Statistical tests included the Shapiro-Wilk, Tukey's post hoc, and Kruskal-Wallis tests, among others.
Results: Group 1 patients were significantly younger and less severely ill (based on SAPS 3 score and admission SOFA) than those in Groups 2 and 3, and their length of ICU stay was shorter. Furthermore, both their ICU (3.4%) and hospital (8.6%) mortality was significantly lower, compared to that of Group 2 and 3 patients. Among these, patients in Group 3 were older and had significantly higher mortality, both in the ICU (27.3% versus 10.1%, p < 0.001) and hospital (53.8% versus 14.9%, p < 0.001), compared to Group 2 patients. We discovered an independent association between age ≥ 66 years, the Charlson Comorbidity Index, prolonged vasopressor use, and hospital mortality.
Conclusion: We demonstrated that the admission SOFA score and 48-hour delta SOFA are predictors of prognosis in a non-selective cohort of critically ill patients.
Trial registration: The study protocol was retrospectively registered at ClinicalTrials.gov (NCT04980274, July 27, 2021.)