Sequential Organ Failure Assessment scores and mortality

Introduction

In 2005, in a multicenter study in 79 ICUs in Spain, Cabré and colleagues [1] found patients older than 60 years and with SOFA score higher than 9 for at least 5 days unlikely to survive, suggesting that it could provide a basis for deciding whether to withhold or withdraw life support. We tried to control their hypothesis in our patient population.

Methods

We reviewed the data of the patients older than 60 years and with a LOS higher than 5 days admitted to our ICU in 2007. We calculated the daily SOFA score of the patients with an initial SOFA score higher than 9. IGSII, LOS and mortality were compared between patients with a SOFA score higher than 9 for at least 5 days (SOFA(+) group) and the other selected patients (SOFA(-) group).

Results

In 2007, 430 patients were admitted to our ICU. One hundred and forty were older than 60 years and remained more than 5 days in the ICU. Eleven of these patients had a SOFA score higher than 9 during 5 days or more. In the SOFA(+) group, LOS (22.6 ± 13.1 vs 10.8 ± 6.9 days) and mortality (55% vs 33%) are significantly higher (P < 0.05). The mortality of 55% is in good agreement with the predicted IGSII mortality but far less than the 100% predicted by Cabré and colleagues.

Conclusions

A SOFA score higher than 9 for at least 5 days in patients older than 60 years seems useless to define futility in our patient population. It is applicable to only less than 3% of the 430 patients admitted in 2007. The mortality rate of the SOFA(+) group increased but remained far from values permitting to withdraw or withhold intensive care. A weakness of the use of sequential SOFA score to predict outcome is that some therapeutic options can influence the value of the SOFA score.