Combining Sequential Organ Failure Assessment (SOFA) Score with Acute Physiology and Chronic Health Evaluation (APACHE) II Score to Predict Hospital Mortality of Critically Ill Patients

• Published in: Anaesthesia and intensive care Vol. 35; no. 4; pp. 515 - 521
• Main Author: Ho, K. M.
• Format: Journal Article
• Language: English
• Published: Edgecliff Anaesthesia and Intensive Care 01.08.2007; Sage Publications Ltd
• Subjects: Adult; Aged; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; APACHE; Biological and medical sciences; Cohort Studies; Critical Illness - mortality; Female; Hospital Mortality; Humans; Male; Medical sciences; Middle Aged; Multiple Organ Failure - diagnosis; Multiple Organ Failure - mortality; Regression Analysis; ROC Curve; Severity of Illness Index; Western Australia - epidemiology; Western Australia; Human; severity of illness; Chronic; Prognosis; Critically ill; Mortality; prognostication; Risk factor; Anesthesia; outcomes assessment; risk adjustment
• ISSN: 0310-057X; 1448-0271
• DOI: 10.1177/0310057X0703500409

The ability to accurately adjust for the severity of illness in outcome studies of critically ill patients is essential. Previous studies have showed that Sequential Organ Failure Assessment (SOFA) score and Acute Physiology and Chronic Health Evaluation (APACHE) II score can predict hospital mortality of critically ill patients. The effects of combining these two scores to predict hospital mortality of critically ill patients has not been evaluated. This cohort study evaluated the performance of combining the APACHE II score with SOFA score in predicting hospital mortality of critically ill patients. A total of 1,311 consecutive adult patients admitted to a tertiary 22-bed multidisciplinary intensive care unit (ICU) in Western Australia were considered. The APACHE II, Admission SOFA, Delta SOFA and maximum SOFA score were all related to hospital survival in the univariate analyses. Combining Max SOFA (area under receiver operating characteristic curve 0.875 vs. 0.858, P=0.014; Nagelkerke R 2 : 0.411 vs. 0.371; Brier Score: 0.086 vs. 0.090) or Delta SOFA score (area under receiver operating characteristic curve 0.874 vs. 0.858, P=0.003; Nagelkerke R 2 : 0.412 vs. 0.371; Brier Score: 0.086 vs. 0.090) with the APACHE II score improved the discrimination and overall performance of the predictions when compared with using the APACHE II score alone, especially in the emergency ICU admissions. Combining Max SOFA or Delta SOFA score with the APACHE II score may improve the accuracy of risk adjustment in outcome studies of critically ill patients.