Extrarenal sequential organ failure assessment score as an outcome predictor of critically ill children on continuous renal replacement therapy.
BACKGROUND
The sequential organ failure assessment (SOFA) score is easy to calculate and has been well validated as an outcome predictor in critically ill adult patients. However, its use in children has been limited, mainly because of differences in basal reference levels of serum creatinine.


METHODS
Data include 87 patients requiring continuous renal replacement therapy (CRRT) between January 2005 and July 2011. We modified the SOFA score by excluding the renal component to an extrarenal SOFA score, based on the assumption that CRRT may mitigate the renal effect on outcome and investigated the utility in predicting outcome with comparison with pediatric risk of mortality (PRISM) III, pediatric logistic organ dysfunction (PELOD), and SOFA scores.


RESULTS
Results showed that 95.4 % (n = 83) had multiple organ dysfunction syndrome with an overall mortality of 50.6 %. The extrarenal SOFA score at CRRT initiation and ≥20 % fluid overload were significantly associated with mortality. In comparison with the predictive power of various scoring systems, the extrarenal SOFA score showed the largest area under the receiver operating characteristic curve (extrarenal SOFA 0.774, SOFA 0.770, PRISM III 0.660, and PELOD 0.650).


CONCLUSIONS
The extrarenal SOFA score may be a useful prognostic marker in critically ill children treated with CRRT.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro-43-gil, Songpa-gu, Seoul, 138-736, Korea.
Won Kyoung
WK
Jhang
Young A
YA
Kim
Eun Ju
EJ
Ha
Yoon Jung
YJ
Lee
Ju Hoon
JH
Lee
Young Seo
YS
Park
Seong Jong
SJ
Park
D019540:Area Under Curve; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000503:physiopathology / Q000628:therapy; D063305:Organ Dysfunction Scores; D012372:ROC Curve; D017582:Renal Replacement Therapy; D016896:Treatment Outcome