title: Value of the SOFA score as a predictive model for short-term survival in high-risk liver transplant recipients with a pre-transplant labMELD score ≥ 30.
abstract: BACKGROUND
  The Sequential Organ Failure Assessment (SOFA) score has been applied for the prediction of survival in critically ill patients. We analysed the value of the SOFA score for the prediction of short-term survival after liver transplantation in high-risk liver transplant recipients with a labMELD score ≥30.
  
  
  METHODS
  We conducted a retrospective single-centre analysis including 88 consecutive liver transplants in adults between January 1, 2007 and December 31, 2010 with a pre-transplant labMELD score ≥30. The SOFA score was assessed preoperatively, directly after transplantation and on post-operative days (PODs) 1-10. Combined and living-related liver transplants were excluded. Receiver operating characteristic (ROC) curve analysis with the Hosmer-Lemeshow test and application of the Brier score were used to calculate sensitivity, specificity, overall model correctness and calibration. Cutoff values were selected with the best Youden index.
  
  
  RESULTS
  ROC curve analysis showed areas under the curve (AUROCs) >0.8 for the SOFA score on PODs 1-10 for the prediction of hospital mortality, 30-day mortality and 3-month mortality with Hosmer-Lemeshow test results that confirmed good model calibration (p > 0.05). The Brier score demonstrated an accuracy of prediction (<0.25) of hospital mortality, 30-day mortality and 3-month mortality for the SOFA scores on PODs 4-9 indicating superior accuracy on PODs 7 and 8 with cutoff values for the SOFA score between 16.5 and 18.5. The pre-transplant SOFA score failed to reach AUROCs >0.7 (0.603-0.663) for the prediction of short-term survival.
  
  
  CONCLUSIONS
  Our results confirm the usefulness of the SOFA score in high-risk liver recipients during the early post-operative course, especially on PODs 7-8 for the prediction of hospital mortality, 30-day mortality and 3-month mortality and may be useful to predict futile early acute retransplantation.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Medizinische Hochschule Hannover, Hannover, Germany. schrem.harald@mh-hannover.de
authors.forename: Harald
authors.initials: H
authors.lastname: Schrem
authors.forename: Melanie
authors.initials: M
authors.lastname: Reichert
authors.forename: Benedikt
authors.initials: B
authors.lastname: Reichert
authors.forename: Thomas
authors.initials: T
authors.lastname: Becker
authors.forename: Frank
authors.initials: F
authors.lastname: Lehner
authors.forename: Moritz
authors.initials: M
authors.lastname: Kleine
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Bektas
authors.forename: Kai
authors.initials: K
authors.lastname: Johanning
authors.forename: Christian P
authors.initials: CP
authors.lastname: Strassburg
authors.forename: Jürgen
authors.initials: J
authors.lastname: Klempnauer
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D005858:Germany; D006084:Graft Rejection / Q000401:mortality*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D053208:Kaplan-Meier Estimate; D017093:Liver Failure / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality* / Q000503:physiopathology; D011182:Postoperative Care / Q000379:methods; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014019:Tissue Donors