Application of the Sequential Organ Failure Assessment Score to Cardiac Surgical Patients

• Published in: Chest Vol. 123; no. 4; pp. 1229 - 1239
• Main Authors: Ceriani, Roberto, Mazzoni, Maurizio, Bortone, Franco, Gandini, Sara, Solinas, Costantino, Susini, Giuseppe, Parodi, Oberdan
• Format: Journal Article
• Language: English
• Published: Northbrook, IL Elsevier Inc 01.04.2003; American College of Chest Physicians
• Subjects: Aged; Biological and medical sciences; Cardiac Output; cardiac surgical procedures; Confidence Intervals; Creatinine; Critical Illness; Female; Heart Diseases - surgery; Hemoglobin; Hospitals; Humans; Intensive care; Male; Medical sciences; Middle Aged; Morbidity; Mortality; Multiple organ dysfunction syndrome; multiple organ failure; outcome assessment; Patients; postoperative complications; Proportional Hazards Models; ROC Curve; Severity of Illness Index; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Urine; RR; df; intensive care; critical illness; CI; Fio2; AUROC; multiple organ failure; SOFA; CPB; maxSOFA; severity of illness index; cardiac surgical procedures; postoperative complications; outcome assessment; TMS; Heart; Human; Prognosis; Mortality; Multiple organ failure; Risk analysis; Morbidity; Intensive care unit; Surgery; Classification; Complication; Severity score
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.123.4.1229

To assess the applicability of the sequential organ failure assessment (SOFA) score to cardiac surgical patients. Observational cohort study. Adult cardiac surgical ICU. Two hundred eighteen patients requiring ICU stay > 96 h. The SOFA score was calculated daily until ICU discharge. Derived SOFA variables—total maximum SOFA (TMS), ΔSOFA, maximum SOFA (maxSOFA), and ΔmaxSOFA—were considered. Length of ICU stay was 8.9 ± 6.7 days (mean ± SD). The mortality rate was 11.0% in the ICU and 15.6% in the hospital. Nonsurvivors had higher TMS, ΔSOFA, single-organ system, and mean total scores on day 1 (9.8 ± 2.5 vs 7.8 ± 2.3, p < 0.05) and thereafter until day 10. The total SOFA score on the first 10 days of ICU stay, time, survival status, and their interaction were all significant (p < 0.001), with higher SOFA scores for nonsurvivors, and lower scores for survivors that decreased as the number of days from operation increased. Cardiovascular score on day 1 carried the highest relative risk of mortality among other systems (risk ratio [RR], 2.12; 95% confidence interval [CI], 1.31 to 3.45; p < 0.01), as did maximum cardiovascular score (RR, 2.81; 95% CI, 1.62 to 4.85; p < 0.001). A growing number of failing organs was associated with mortality, from the first to the sixth postoperative day (p < 0.05). Total score on day 1, TMS, ΔSOFA, maxSOFA, and ΔmaxSOFA were reliable predictors of mortality with area under receiver operating characteristic curve of 0.71 (SE, 0.08), 0.89 (SE, 0.05), 0.86 (SE, 0.06), 0.88 (SE, 0.05), and 0.88 (SE, 0.06), respectively. Length of hospital stay was significantly associated (p = 0.05) to TMS and ΔSOFA and not to other SOFA scores, age, or sex. The SOFA score may be used to grade the severity of postoperative morbidity in cardiac surgical patients without specific adaptations. The model identifies patients at increased risk for postoperative mortality.