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Sequential Organ Failure Assessment score trends and sepsis survival in a Brazilian university hospital intensive care unit

Introduction

Sepsis is associated with progressive organ failure. We sought to describe Sequential Organ Failure Assessment (SOFA) score daily trends in septic patients and tried to correlate those trends with survival.

Methods

Patients with severe sepsis or septic shock admitted for at least 5 days in a seven-bed medicosurgical ICU of a Brazilian university hospital were studied. The daily SOFA score for each patient was calculated during the first 5 days of admission. Relevant data were prospectively acquired from March 2003 to May 2006 and the latter retrieved from a electronic database. ICU survivors were compared with nonsurvivors using the Mann–Whitney U test. Day-to-day changes were verified within each group using Friedman's test. P ≤ 0.01 was elected as the significance limit. Medians and interquartile ranges (IQRs) were used to describe the sample.

Results

One hundred and seventy-six patients were studied (71 males (56%), median age 51 (IQR 36–67) years, 78 (44%) with severe sepsis, median length of ICU stay 10 days (IQR 7–16), median admission SOFA 6 (IQR 4–9), median APACHE II score 19 (IQR 13–26), ICU mortality 27.84% (49/176 patients)). The SOFA score and its components scores along the five admission days distinguished the survivors from the nonsurvivors. Considering the SOFA score and its respiratory, neurologic and circulatory components, survivors presented lower scores as the days passed (P < 0.001). Mortality was increasingly higher for those patients who persisted with a SOFA score ≥7 as the days passed.

Conclusion

In the sample studied, the persistence of an elevated SOFA score and its components during the first 5 days of admission predicted a higher mortality. Survival appears to be related to early organ dysfunction recovery. The SOFA score and SOFA-related variables' day-to-day changes in a population of septic patients may have an important prognostic implication and some patterns of daily evolution may distinguish those patients with a more ominous outcome.

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Lima, D.M., de Almeida, B.F.C., Cordioli, R. et al. Sequential Organ Failure Assessment score trends and sepsis survival in a Brazilian university hospital intensive care unit. Crit Care 11, P465 (2007). https://doi.org/10.1186/cc5625

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Keywords

  • Severe Sepsis
  • Septic Patient
  • Sequential Organ Failure Assessment
  • Sequential Organ Failure Assessment Score
  • Hospital Intensive Care Unit