COMPARISON OF PATIENTS' ADMISSION, MEAN AND HIGHEST SOFA SCORES IN PREDICTION OF ICU MORTALITY: A PROSPECTIVE OBSERVATIONAL STUDY.

BACKGROUND: Use of valid criteria for evaluation of patients admitted to intensive care unit (ICU) is essential to assess the quality of services provided. This study was conducted to evaluate admission, mean and the highest Sequential Organ Failure Assessment (SOFA) scores in predicting mortality and outcome of patients admitted to the ICU.

METHODS: This prospective observational study was conducted on 300 patients admitted to the ICU of Imam Khomeini Hospital, Sari, Iran, in 2015. The SOFA tool was applied at the beginning of the admission of patients in the ICU and then every 24 hours. Functions of six vital organs were recorded on a daily basis for scoring with SOFA. Demographic profile, the main diagnosis leading to hospitalization in the ICU, previous interventions, complications and hospital outcomes were recorded for each patient. The patients' admission, mean and highest SOFA scores were also evaluated and recorded during the study period. These scores were compared between deceased and survived patients. ROC curve determined the best cut-off point of score calculated.

RESULTS: Among all 300 patients who were enrolled in the study, 189 (63%) cases were males. Trauma was the most common cause of hospitalization and mortality. Thirty point seven percent of 92 deceased patients needed to intubation. Mean length of ICU and hospital stay were significantly longer for deceased patients than the survivors (P <0.001). The admission, mean and highest SOFA scores were 11.72, 16.38 and 16.45 in deceased patients, as well as 6.52, 5.82 and 6.5 in survived patients, respectively. The area under the curve (AUC) for the admission, mean and highest SOFA scores were 0.875, 0.988 and 0982, respectively. All three models were able to predict the outcome of patients significantly (P <0.0001). The cut-off point of 10.6 for the mean SOFA had the highest sensitivity and specificity in predicting mortality.

CONCLUSION: The results of this study showed that the mean SOFA score had the highest sensitivity and specificity in prediction of ICU mortality. Therefore, this criterion is a valuable indicator to better predictions of mortality and morbidity rate in the ICU patients, which can lead to appropriate health care and therapeutic interventions in these patients.