Sequential organ failure assessment score as the determinant of outcome for patients with severe sepsis.
OBJECTIVE
To evaluate the impact of organ dysfunction in severe sepsis and determine the effectiveness of organ dysfunction scores to discriminate outcome after admission to the intensive care unit (ICU).


METHODS
Patients with a diagnosis of severe sepsis and at least one organ dysfunction on the first day in the ICU (n=117) were included in the prospective observational study. The presence of organ dysfunction was assessed using a Sequential Organ Failure Assessment (SOFA). The severity of illness was assessed using a Simplified Acute Physiology Score (SAPS) II during the first 24 hours after the admission to the ICU. The main outcome was survival status on day 28 after admission to the ICU.


RESULTS
Most common sites of infection were intra-abdominal and respiratory system (77 and 38 cases, respectively). Median SAPS II score on admission was 47 points (25th-75th quartiles range, 37-57 points). Twenty eight days survival rate was 41%. The best discrimination results were shown for cumulative scores with the highest for the SOFA score on day 3 in the ICU. The ability to discriminate outcome on day 1 was weak for the presence of dysfunction in all organ systems except neurological. The discriminative power of organ dysfunction scores increased during the stay in the ICU. Neurological and cardiovascular dysfunctions were the independent risk factors for mortality.


CONCLUSIONS
The SOFA scores showed high accuracy in describing the course of organ dysfunction for the patients with severe sepsis. Evolving organ dysfunction following admission to the ICU strongly affected the outcome. Cumulative SOFA scores were better in discriminating outcome compared to single organ dysfunction scores.
Vosylius
Saulius
S
Clinic of Anesthesiology and Intensive Care, Vilnius University Emergency Hospital, Siltnamiu 29, 04130 Vilnius-43, Lithuania.
Sipylaite
Jurate
J
Ivaskevicius
Juozas
J
D000368:Aged; D006801:Humans; D007362:Intensive Care Units; D008097:Lithuania / Q000453:epidemiology; D016015:Logistic Models; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis*; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis* / Q000401:mortality; D012720:Severity of Illness Index; D015996:Survival Rate