Association of the SOFA score and mortality in elderly patients with severe sepsis and septic shock
© BioMed Central Ltd 2005
Published: 9 June 2005
The SOFA score is an excellent predictive marker of outcome in sepsis; however, there are very few studies that relate it to mortality in elderly patients with sepsis and septic shock.
To assess the association of the SOFA score and other factors related to mortality in elderly patients with severe sepsis and septic shock.
A 3-month prospective cohort study of 30 patients aged ≥ 65 showing severe sepsis or septic shock . Arterial hypotension (systolic arterial pressure <90 mmHg) corresponded to the 'time-zero' of the study. The variables used were: the SOFA score on days 1, 3, 5, 7, 14, and 28, (Δ)SOFA (variation of the SOFA score on days 1 and 3), APACHE II score, troponin I dosage, BNP and PCR, plasma glucose levels, organ failures , the presence of previous cardiovascular disease, assessment of dependence and cognitive deficit [3, 4], length of ICU stay, and need for mechanical ventilation. We used Student's t test and the Fischer exact test for a statistical analysis. We considered the significance level of 5%.
The mean age of patients, of whom 60% were female, was 82 ± 9 years (minimum = 65 years, maximum = 99 years). The predominant diagnosis was septic shock in 67% of the cases, while 33% of the patients developed severe sepsis. On days 1, 3, 5, 7, 14, and 28, the SOFA score presented mean values of 7, 6, 4, 3, 2, and 2, respectively (minimum = 2 and maximum = 15), thus evidencing a significant relationship between the SOFA score on day 1 (P = 0.0001) and day 3 (P = 0.001), including (Δ)SOFA score (P = 0.043), and mortality. The number of failures was also associated with mortality when two or more organ failures (P = 0.001) were present. The age, gender, APACHE II score, length of ICU stay, dependence level, presence of cognitive deficit and/or previous cardiovascular diseases, plasma glucose levels, troponin I, BNP and PCR were not associated with mortality.
A mean SOFA average above 5 as well as SOFA variation within the first 72 hours proved to be good predictive markers in elderly patients with septic shock and severe sepsis. The same occurred in the presence of two or more organ failures during the course of sepsis.
- American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992, 20: 864-874.View ArticleGoogle Scholar
- Le Gall JR, Klar J, Lemeshow S, Saulnier F, Alberti C, Artigas A, Teres D, Le Gall JR, Brun-Buisson C, Trunet P, Latournerie J, Chantereau S, Rapin M: Influence of age, previous health status, and severity of acute illness on outcome from intensive care. Crit Care Med 1982, 10: 575-577.View ArticlePubMedGoogle Scholar
- Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW: Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963, 185: 914-919.View ArticlePubMedGoogle Scholar
- Lawton MP, Brody EM: Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969, 9: 179-186.View ArticlePubMedGoogle Scholar