title: Use of the sequential organ failure assessment score as a severity score.
abstract: OBJECTIVE
  To evaluate whether the SOFA score can be used to develop a model to predict intensive care unit (ICU) mortality in different countries.
  
  
  METHODS
  Analysis of a prospectively collected database. Patients with ICU stay longer than 2 days were studied to develop a mortality prediction model based on measurements of organ dysfunction.
  
  
  METHODS
  748 patients from six countries.
  
  
  RESULTS
  Two logistic regression models were constructed, one based on the SOFA maximum (SOFA Max model) and the other on variables identified by multivariate regression (SOFA Max-infection model). The H and C statistics had a p value above 0.05 for both models, but the D statistics showed a poor performance on the SOFA Max model when stratified for the presence of infection. Subsequent analysis was performed with SOFA Max-infection model. The area under the curve was 0.853. There were no statistically significant differences in observed and predicted mortalities except for one country which had a higher than predicted ICU mortality both in the overall population (28.3 vs. 19.1%) and in the noninfected patients (21.4 vs. 12.6%).
  
  
  CONCLUSIONS
  The SOFA Max adjusted for age and the presence of infection can predict mortality in this population, but in one country the ICU mortality was higher than expected. Our data do not allow us to determine the reasons behind these differences, and further studies to detect differences in mortality between countries and to elucidate the basis for these differences should be encouraged.
authors.affiliation: Department of Intensive Care, Erasme Hospital, Free University of Brussels, Route de Lennik 808, 1070 Brussels, Belgium.
authors.forename: André Carlos
authors.initials: AC
authors.lastname: Kajdacsy-Balla Amaral
authors.forename: Fábio Moreira
authors.initials: FM
authors.lastname: Andrade
authors.forename: Rui
authors.initials: R
authors.lastname: Moreno
authors.forename: Antonio
authors.initials: A
authors.lastname: Artigas
authors.forename: Francis
authors.initials: F
authors.lastname: Cantraine
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
mesh_terms: D000704:Analysis of Variance; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate