The Sequential Organ Failure Assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation

Alan E. Jones, Stephen Trzeciak, Jeffrey Kline

Research output: Contribution to journalArticle

179 Citations (Scopus)

Abstract

Objectives: Organ failure worsens outcome in sepsis. The Sequential Organ Failure Assessment (SOFA) score numerically quantifies the number and severity of failed organs. We examined the utility of the SOFA score for assessing outcome of patients with severe sepsis with evidence of hypoperfusion at the time of emergency department (ED) presentation. Design: Prospective observational study. Setting: Urban, tertiary ED with an annual census of >110,000. Patients: ED patients with severe sepsis with evidence of hypoperfusion. Inclusion criteria: suspected infection, two or more criteria of systemic inflammation, and either systolic blood pressure <90 mm Hg after a fluid bolus or lactate >4 mmol/L. Exclusion criteria: age <18 years or need for immediate surgery. Interventions: SOFA scores were calculated at ED recognition (T0) and 72 hours after intensive care unit admission (T72). The primary outcome was in-hospital mortality. The area under the receiver operating characteristic curve was used to evaluate the predictive ability of SOFA scores at each time point. The relationship between Δ SOFA (change in SOFA from T0 to T72) was examined for linearity. Results: A total of 248 subjects aged 57 ± 16 years, 48% men, were enrolled over 2 years. All patients were treated with a standardized quantitative resuscitation protocol; the in-hospital mortality rate was 21%. The mean SOFA score at T0 was 7.1 ± 3.6 points and at T72 was 7.4 ± 4.9 points. The area under the receiver operating characteristic curve of SOFA for predicting in-hospital mortality at T0 was 0.75 (95% confidence interval 0.68-0.83) and at T72 was 0.84 (95% confidence interval 0.77-0.90). The Δ SOFA was found to have a positive relationship with in-hospital mortality. Conclusions: The SOFA score provides potentially valuable prognostic information on in-hospital survival when applied to patients with severe sepsis with evidence of hypoperfusion at the time of ED presentation.

Original languageEnglish (US)
Pages (from-to)1649-1654
Number of pages6
JournalCritical Care Medicine
Volume37
Issue number5
DOIs
StatePublished - Jan 1 2009
Externally publishedYes

Fingerprint

Organ Dysfunction Scores
Hospital Emergency Service
Sepsis
Hospital Mortality
ROC Curve
Confidence Intervals
Blood Pressure
Censuses
Resuscitation
Observational Studies
Intensive Care Units
Prospective Studies
Inflammation
Survival
Mortality
Infection

Keywords

  • Mortality
  • Scoring system
  • Sepsis
  • Sequential Organ Failure Assessment
  • Severe sepsis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

@article{0314242da38b400d99233ed3d53876aa,
title = "The Sequential Organ Failure Assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation",
abstract = "Objectives: Organ failure worsens outcome in sepsis. The Sequential Organ Failure Assessment (SOFA) score numerically quantifies the number and severity of failed organs. We examined the utility of the SOFA score for assessing outcome of patients with severe sepsis with evidence of hypoperfusion at the time of emergency department (ED) presentation. Design: Prospective observational study. Setting: Urban, tertiary ED with an annual census of >110,000. Patients: ED patients with severe sepsis with evidence of hypoperfusion. Inclusion criteria: suspected infection, two or more criteria of systemic inflammation, and either systolic blood pressure <90 mm Hg after a fluid bolus or lactate >4 mmol/L. Exclusion criteria: age <18 years or need for immediate surgery. Interventions: SOFA scores were calculated at ED recognition (T0) and 72 hours after intensive care unit admission (T72). The primary outcome was in-hospital mortality. The area under the receiver operating characteristic curve was used to evaluate the predictive ability of SOFA scores at each time point. The relationship between Δ SOFA (change in SOFA from T0 to T72) was examined for linearity. Results: A total of 248 subjects aged 57 ± 16 years, 48{\%} men, were enrolled over 2 years. All patients were treated with a standardized quantitative resuscitation protocol; the in-hospital mortality rate was 21{\%}. The mean SOFA score at T0 was 7.1 ± 3.6 points and at T72 was 7.4 ± 4.9 points. The area under the receiver operating characteristic curve of SOFA for predicting in-hospital mortality at T0 was 0.75 (95{\%} confidence interval 0.68-0.83) and at T72 was 0.84 (95{\%} confidence interval 0.77-0.90). The Δ SOFA was found to have a positive relationship with in-hospital mortality. Conclusions: The SOFA score provides potentially valuable prognostic information on in-hospital survival when applied to patients with severe sepsis with evidence of hypoperfusion at the time of ED presentation.",
keywords = "Mortality, Scoring system, Sepsis, Sequential Organ Failure Assessment, Severe sepsis",
author = "Jones, {Alan E.} and Stephen Trzeciak and Jeffrey Kline",
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T1 - The Sequential Organ Failure Assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation

AU - Jones, Alan E.

AU - Trzeciak, Stephen

AU - Kline, Jeffrey

PY - 2009/1/1

Y1 - 2009/1/1

N2 - Objectives: Organ failure worsens outcome in sepsis. The Sequential Organ Failure Assessment (SOFA) score numerically quantifies the number and severity of failed organs. We examined the utility of the SOFA score for assessing outcome of patients with severe sepsis with evidence of hypoperfusion at the time of emergency department (ED) presentation. Design: Prospective observational study. Setting: Urban, tertiary ED with an annual census of >110,000. Patients: ED patients with severe sepsis with evidence of hypoperfusion. Inclusion criteria: suspected infection, two or more criteria of systemic inflammation, and either systolic blood pressure <90 mm Hg after a fluid bolus or lactate >4 mmol/L. Exclusion criteria: age <18 years or need for immediate surgery. Interventions: SOFA scores were calculated at ED recognition (T0) and 72 hours after intensive care unit admission (T72). The primary outcome was in-hospital mortality. The area under the receiver operating characteristic curve was used to evaluate the predictive ability of SOFA scores at each time point. The relationship between Δ SOFA (change in SOFA from T0 to T72) was examined for linearity. Results: A total of 248 subjects aged 57 ± 16 years, 48% men, were enrolled over 2 years. All patients were treated with a standardized quantitative resuscitation protocol; the in-hospital mortality rate was 21%. The mean SOFA score at T0 was 7.1 ± 3.6 points and at T72 was 7.4 ± 4.9 points. The area under the receiver operating characteristic curve of SOFA for predicting in-hospital mortality at T0 was 0.75 (95% confidence interval 0.68-0.83) and at T72 was 0.84 (95% confidence interval 0.77-0.90). The Δ SOFA was found to have a positive relationship with in-hospital mortality. Conclusions: The SOFA score provides potentially valuable prognostic information on in-hospital survival when applied to patients with severe sepsis with evidence of hypoperfusion at the time of ED presentation.

AB - Objectives: Organ failure worsens outcome in sepsis. The Sequential Organ Failure Assessment (SOFA) score numerically quantifies the number and severity of failed organs. We examined the utility of the SOFA score for assessing outcome of patients with severe sepsis with evidence of hypoperfusion at the time of emergency department (ED) presentation. Design: Prospective observational study. Setting: Urban, tertiary ED with an annual census of >110,000. Patients: ED patients with severe sepsis with evidence of hypoperfusion. Inclusion criteria: suspected infection, two or more criteria of systemic inflammation, and either systolic blood pressure <90 mm Hg after a fluid bolus or lactate >4 mmol/L. Exclusion criteria: age <18 years or need for immediate surgery. Interventions: SOFA scores were calculated at ED recognition (T0) and 72 hours after intensive care unit admission (T72). The primary outcome was in-hospital mortality. The area under the receiver operating characteristic curve was used to evaluate the predictive ability of SOFA scores at each time point. The relationship between Δ SOFA (change in SOFA from T0 to T72) was examined for linearity. Results: A total of 248 subjects aged 57 ± 16 years, 48% men, were enrolled over 2 years. All patients were treated with a standardized quantitative resuscitation protocol; the in-hospital mortality rate was 21%. The mean SOFA score at T0 was 7.1 ± 3.6 points and at T72 was 7.4 ± 4.9 points. The area under the receiver operating characteristic curve of SOFA for predicting in-hospital mortality at T0 was 0.75 (95% confidence interval 0.68-0.83) and at T72 was 0.84 (95% confidence interval 0.77-0.90). The Δ SOFA was found to have a positive relationship with in-hospital mortality. Conclusions: The SOFA score provides potentially valuable prognostic information on in-hospital survival when applied to patients with severe sepsis with evidence of hypoperfusion at the time of ED presentation.

KW - Mortality

KW - Scoring system

KW - Sepsis

KW - Sequential Organ Failure Assessment

KW - Severe sepsis

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