SEQUENTIAL ORGAN FAILURE ASSESSMENT SCORE

IntroductionSeverity of illness scoring systems – widely

used in critical care units.

Purpose:RCTs & Clinical Research - ComparabilityAdministrative purpose – Allocation of

resourcesICU – Assessment of performancePatients – Individual prognosis & guiding

care

Types of Severity Scoring Systems

First Day Scoring SystemsAPACHE (Acute Physiology & Chronic Health Condition)SAPS (Simplified Acute Physiology Score)MPM (Mortality Prediction Model)

Repetative Scoring SystemsOSF (Organ System Failure)MODS (Multiple Organ Dysfunction Score)SOFA (Sequential Organ Failure Asssessment)

SOFA – Historical Perspective1994 - “Sepsis” Related Organ Failure

Assessment (European Society of Intensive Care Medicine)

Renamed to “Sequential” Organ Failure Assessment

SOFA - Components

Neurological GCSCardiovascular MAP

Vasopressor UseRenal Serum Creatine

Urine OutputRespiratory Pao2/Fio2 ratio

Mecahanical Ventilation

Hematological Platelet CountHepatic Serum Bilirubin

SOFA - Components

SOFA - Components

Neurological GCSCardiovascular MAP

Vasopressor UseRenal Serum Creatine

Urine OutputRespiratory Pao2/Fio2 ratio

Mecahanical Ventilation

Hematological Platelet CountHepatic Serum Bilirubin

SOFA - ValidationValided for both medical & surgical ICU

patients. (Vincent JL, Moreno R. Clinical review: scoring systems in the

critically ill. Crit Care. 2010;14(2):207.)

Maximum total SOFA > 15 - mortality rate of 90%.

(Vincent JL, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26(11):1793-800)

SOFA - ValidationIncrease during the first 48 hours in the ICU,

independent of the initial score - mortality rate of at least 50%; decrease - 27%.

(Ferreira FL, Bota DP, Bross A, Melot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001;286(14):1754-8.)

100% mortality in patients with >60 years, a total maximum SOFA >13 on any of the first 5 days of ICU admission, minimum SOFA >10 at all times, and a positive or unchanged SOFA trend over the first 5 days of ICU admission.

(Cabre L, Mancebo J, Solsona JF, Saura P, Gich I, Blanch L, et al. Multicenter study of the multiple organ dysfunction syndrome in intensive care units: the usefulness of Sequential Organ Failure Assessment scores in decision making. Intensive Care Med. 2005;31(7):927-33)

SOFA – Application to Cardiac Surgical PatientsObservational cohort study.Adult cardiac surgical ICU.218 patients requiring ICU stay >96 hours.Conclusion – Reliable & onjective description of

ongoing course of organ impairment after cardiac surgery.

(Ceriani R, Mazzoni M, Bortone F, Gandini S, Solinas C, Susini G, et al. Application of the sequential organ failure assessment score to cardiac surgical patients. Chest. 2003;123(4):1229-39.)

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