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When is the 'golden time' to apply the SOFA score in critically ill patients?


Multiple organ failure is the main cause of mortality in intensive care units (ICUs). Initial treatment is probably the most important step for critically ill patient outcome. Many scores have been proposed to assess organ dysfunction evolution and outcome. However, the ideal time to apply organ dysfunction scores has not been clearly established. We hypothesized that the SOFA score, when applied after initial treatment (24 hours later on), is more valuable than at the ICU admission to predict outcome in critically ill patients.


To evaluate whether SOFA score calculation after treatment is more adequate to predict outcome than SOFA score calculation at ICU admission in critically ill patients.


This is a prospective analysis from the BASES study, which is an epidemiological, observational study performed in 1379 patients from private and public Brazilian ICUs. From this databank, we selected only patients with a length of stay longer than 24 hours (n = 884). From those patients, we calculated the daily SOFA score at admission and 24 hours later, and we also collected patient related outcome. The Youden test was calculated to choose the best cut-off value. Receiver-operating characteristic (ROC) curves were built for SOFA scores in those days. Finally, we compared the areas under ROC curves throughout a Hanley and McNeil test to estimate the most appropriate day to apply this organ dysfunction descriptor. P = 0.0002 was considered significant.


The mean age was 62 ± 19 years, 59% were male, and the overall mortality rate was 22%. The best cut-off value for SOFA score at day of admission was 8 and for the next day was 5. Areas under the ROC curves were 0.716 and 0.775 for day of admission and the next day, respectively (P < 0.05).


The SOFA score applied after initial resuscitation is more accurate to predict outcome than the SOFA score applied at ICU admission.

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Sogayar, A., Silva, E., Cal, R. et al. When is the 'golden time' to apply the SOFA score in critically ill patients?. Crit Care 7, P33 (2003).

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  • Intensive Care Unit
  • Initial Treatment
  • Organ Dysfunction
  • Multiple Organ Failure
  • Prospective Analysis