The use of the SOFA score to analyze the profile and severity of organ dysfunction in patients with cardiovascular disorders

Background

Multiple organ dysfunction has become the leading cause of morbidity and mortality in intensive care, making it necessary to understand, test and validate evaluation systems for this syndrome.

Objective

To evaluate the profile of clinical evolution and severity of cardiovascular patients using a dysfunction organ score (Sequential Organ Failure Assessment [SOFA]).

Design

An observational cohort study.

Patients

A total of 569 consecutive cardiovascular patients (326 men, 243 women) admitted to the cardiointensive unit (CIU) between July 2003 and December 2004. Patients with an ICU stay shorter than 12 hours were excluded.

Measurements and main results

To assess the organ dysfunction, we collected data of assailed organ systems, individually, and the total maximum SOFA (TMS). We analyzed the association between basic cardiovascular pathology and admission diagnosis with higher dysfunction organ scores and their impact on mortality. The mean age was 61.1 years, and the length of CIU stay was 5.8 days, with CIU mortality of 13.3%. The median TMS was 3.86, significantly higher in non-survivors (12.0 vs 2.0, P < 0.001). The organ dysfunction, individually or in association, was correlated with higher mortality, and respiratory dysfunction was the highest prevalent (57.3%). With respect to cardiovascular pathology, although there was higher prevalence of ischemic, hypertensive and rheumatic pathology, just the dilated non-ischemic cardiomyopathy (24% non-survivors, P = 0.046) was correlated with higher mortality. Analyzing the admission diagnosis, the presence of cardiogenic shock (72.7% non-survivors, P < 0.0001), pulmonary infection (47.3%, P < 0.0001) and congestive heart failure (27.3%, P = 0.12) associated with higher scores of organ dysfunction and higher mortality. The acute coronary syndrome without ST-segment elevation and atrial arrhythmias, although of higher prevalence, were correlated with lower mortality.

Conclusion

The SOFA score allowed a simple and effective evaluation of organ dysfunction severity profile in patients with heart disease, identifying high morbidity and mortality diseases and high-risk groups, that will enable earlier therapeutic measures and increased monitorization.