title: The sequential organ failure assessment (SOFA) score is an effective triage marker following staggered paracetamol (acetaminophen) overdose.
abstract: BACKGROUND
  The sequential organ failure assessment (SOFA) score is an effective triage marker following single time point paracetamol (acetaminophen) overdose, but has not been evaluated following staggered (multiple supratherapeutic doses over >8 h, resulting in cumulative dose of >4 g/day) overdoses.
  
  
  OBJECTIVE
  To evaluate the prognostic accuracy of the SOFA score following staggered paracetamol overdose.
  
  
  METHODS
  Time-course analysis of 50 staggered paracetamol overdoses admitted to a tertiary liver centre. Individual timed laboratory samples were correlated with corresponding clinical parameters and the daily SOFA scores were calculated.
  
  
  RESULTS
  A total of 39/50 (78%) patients developed hepatic encephalopathy. The area under the SOFA receiver operator characteristic for death/liver transplantation was 87.4 (95% CI 73.2-95.7), 94.3 (95% CI 82.5-99.1), and 98.4 (95% CI 84.3-100.0) at 0, 24 and 48 h, respectively, postadmission. A SOFA score of <6 at tertiary care admission predicted survival with a sensitivity of 100.0% (95% CI 76.8-100.0) and specificity of 58.3% (95% CI 40.8-74.5), compared with 85.7% (95% CI 60.6-97.4) and 75.0% (95% CI 65.2-79.5) , respectively, for the modified Kings College criteria. Only 2/21 patients with an admission SOFA score <6 required renal replacement therapy or intracerebral pressure monitoring. SOFA significantly outperformed the Model for End-stage Liver Disease, but not APACHE II, at 0, 24-and 48-h following admission.
  
  
  CONCLUSIONS
  A SOFA score <6 at tertiary care admission following a staggered paracetamol overdose, is associated with a good prognosis. Both the SOFA and APACHE II scores could improve triage of high-risk staggered paracetamol overdose patients.
authors.affiliation: Scottish Liver Transplantation Unit, Royal Infirmary of Edinburgh, UK.
authors.forename: D G
authors.initials: DG
authors.lastname: Craig
authors.forename: S
authors.initials: S
authors.lastname: Zafar
authors.forename: T W D J
authors.initials: TW
authors.lastname: Reid
authors.forename: K G
authors.initials: KG
authors.lastname: Martin
authors.forename: J S
authors.initials: JS
authors.lastname: Davidson
authors.forename: P C
authors.initials: PC
authors.lastname: Hayes
authors.forename: K J
authors.initials: KJ
authors.lastname: Simpson
mesh_terms: D018806:APACHE; D000082:Acetaminophen / Q000009:adverse effects*; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis*; D062787:Drug Overdose; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009102:Multiple Organ Failure / Q000139:chemically induced*; D011237:Predictive Value of Tests; D013997:Time Factors; D014218:Triage / Q000379:methods
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen