SOFA Score Plus Impedance Ratio Predicts Mortality in Critically Ill Patients Admitted to the Emergency Department: Retrospective Observational Study

• Published in: Healthcare (Basel) Vol. 10; no. 5; p. 810
• Main Authors: Kammar-García, Ashuin, Castillo-Martínez, Lilia, Mancilla-Galindo, Javier, Villanueva-Juárez, José Luis, Pérez-Pérez, Anayeli, Rocha-González, Héctor Isaac, Arrieta-Valencia, Jesús, Remolina-Schlig, Miguel, Hernández-Gilsoul, Thierry
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 27.04.2022; MDPI
• Subjects: Creatinine; critical care; Disease prevention; emergency department; Glasgow Coma Scale; Illnesses; impedance ratio; Laboratories; Mortality; Observational studies; prediction; SOFA; Ventilators; critical care; mortality; prediction; SOFA; impedance ratio; emergency department
• ISSN: 2227-9032; 2227-9032
• DOI: 10.3390/healthcare10050810

The Sequential Organ Failure Assessment (SOFA) is a scoring system used for the evaluation of disease severity and prognosis of critically ill patients. The impedance ratio (Imp-R) is a novel mortality predictor. This study aimed to evaluate the combination of the SOFA + Imp-R in the prediction of mortality in critically ill patients admitted to the Emergency Department (ED). A retrospective cohort study was performed in adult patients with acute illness admitted to the ED of a tertiary-care referral center. Baseline SOFA score and bioelectrical impedance analysis to obtain the Imp-R were performed within the first 24 h after admission to the ED. A Cox regression analysis was performed to evaluate the mortality risk of the initial SOFA score plus the Imp-R. Harrell's C-statistic and decision curve analyses (DCA) were performed. Out of 325 patients, 240 were included for analysis. Overall mortality was 31.3%. Only 21.3% of non-surviving patients died after hospital discharge, and 78.4% died during their hospital stay. Of the latter, 40.6% died in the ED. The SOFA and Imp-R values were higher in non-survivors and were significantly associated with mortality in all models. The combination of the SOFA + Imp-R significantly predicted 30-day mortality, in-hospital mortality, and ED mortality with an area under the curve (AUC) of 0.80 (95% CI: 74-0.86), 0.79 (95% CI: 0.74-0.86) and 0.75 (95% CI: 0.66-0.84), respectively. The DCA showed that combining the SOFA + Imp-R improved the prediction of mortality through the lower risk thresholds. The addition of the Imp-R to the baseline SOFA score on admission to the ED improves mortality prediction in severely acutely ill patients admitted to the ED.