Application of the sequential organ failure assessment score to cardiac surgical patients.
OBJECTIVE
To assess the applicability of the sequential organ failure assessment (SOFA) score to cardiac surgical patients.


METHODS
Observational cohort study.


METHODS
Adult cardiac surgical ICU.


METHODS
Two hundred eighteen patients requiring ICU stay > 96 h.


RESULTS
The SOFA score was calculated daily until ICU discharge. Derived SOFA variables-total maximum SOFA (TMS), DeltaSOFA, maximum SOFA (maxSOFA), and DeltamaxSOFA-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, DeltaSOFA, 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, DeltaSOFA, maxSOFA, and DeltamaxSOFA 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 DeltaSOFA and not to other SOFA scores, age, or sex.


CONCLUSIONS
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.
Ceriani
Roberto
R
Department of Anesthesia and ICU, Humanitas Gavazzeni, Bergamo, Italy.
Mazzoni
Maurizio
M
Bortone
Franco
F
Gandini
Sara
S
Solinas
Costantino
C
Susini
Giuseppe
G
Parodi
Oberdan
O
D000368:Aged; D002302:Cardiac Output; D016001:Confidence Intervals; D016638:Critical Illness; D005260:Female; D006331:Heart Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012372:ROC Curve; D012720:Severity of Illness Index