Feasibility of the modified sequential organ function assessment score in a resource-constrained setting: a prospective observational study

Cornelius Sendagire, Michael S Lipnick, Sam Kizito, Rebecca Kruisselbrink, Daniel Obua, Joseph Ejoku, Lameck Ssemogerere, Jane Nakibuuka, Arthur Kwizera, Cornelius Sendagire, Michael S Lipnick, Sam Kizito, Rebecca Kruisselbrink, Daniel Obua, Joseph Ejoku, Lameck Ssemogerere, Jane Nakibuuka, Arthur Kwizera

Abstract

Background: Sub-Saharan Africa has a great burden of critical illness with limited health care resources. We evaluated the feasibility and utility of the modified Sequential Organ Function Assessment (mSOFA) score in assessing morbidity and mortality in the National Referral Hospital's intensive care unit (ICU) for one year.

Methods: We conducted a prospective, observational cohort study on patients above 12 years of age admitted to the ICU at Mulago Hospital (Kampala, Uganda). All SOFA scores were determined at admission and at 48 h. We modified the SOFA score by replacing the PaO2/FiO2 ratio with SPO2/FiO2. The primary outcome was ICU mortality.

Results: This ICU cohort of 118 patients had a mean age of 37 years and an ICU mortality rate of 46.6%. Non-survivors had higher initial (7.7 SD 3.8 vs. 5.5 SD 3.3; p = 0.007), mean (8.1 SD 3.9 vs 4.7 SD 2.6; p < 0.001) and highest mSOFA scores (9.4 SD 4.2 vs. 5.8 SD 3.2; p < 0.001), with an increase of 1.0 (SD 3.1) mSOFA on average after 48 h when compared to survivors (p < 0.001). The area under the receiver operating characteristic curves for each mSOFA category was: initial-0.68, mean-0.76, highest-0.76 and delta mSOFA-0.74. Multivariate logistic regression analysis showed no significant association between mSOFA scores and mortality.

Conclusion: Our results confirm that calculation of the mSOFA score is feasible for an ICU population in a resource-limited country. More data are needed to test for an association between mSOFA and mortality.

Keywords: Critical care; Illness severity scoring system; Low and middle-income countries; Modified sequential organ function assessment; Mortality.

Figures

Fig. 1
Fig. 1
Enrolment
Fig. 2
Fig. 2
Association of Initial, Mean and Highest mSOFA with Mortality. These graphs demonstrate a direct proportionality relationship between mSOFA scores with mortality even though there was no significant association in the multivariate analysis. a shows the Initial mSOFA score association with mortality. b shows the Mean mSOFA score association with mortality. c shows the highest mSOFA score association with mortality
Fig. 3
Fig. 3
Receiver Operating Curves for mSOFA prediction of mortality. The mSOFA demonstrated a poor to fair prediction of mortality. The initial mSOFA score is represented by Sofatotal1. It showed the lowest predictive power of all categories of the mSOFA. The mSOFA at 48 h, represented by Sofatotal2, had the highest predictive power followed by the mean, highest and delta mSOFA scores

References

    1. Dunser M, Baelani WI, Ganbold L. A review and analysis of intensive care medicine in the least developed countries. Crit Care Med. 2006;34:1234–42. doi: 10.1097/01.CCM.0000208360.70835.87.
    1. Adhikari NK, Fowler RA, Bhagwanjee S, Rubenfeld GD. Critical care and the global burden of critical illness in adults. Lancet. 2010;376:1339–46. doi: 10.1016/S0140-6736(10)60446-1.
    1. Fowler RA, Adhikari NKJ, Bhagwanjee S. Clinical review: critical care in the global context – disparities in burden of illness, access, and economics. Crit Care. 2008;12(225):1–6.
    1. Murthy S, Wunsch H. Clinical review: International comparisons in critical care - lessons learned. Crit Care. 2012;16(218):1–7. doi: 10.1097/01.ccm.0000424312.40576.73.
    1. Vincent J, de Mendonça A, Cantraine F, Moreno R, Takala J, Sprung CL. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the european society of intensive care medicine. Crit Care Med. 1998;26(11):1793–800. doi: 10.1097/00003246-199811000-00016.
    1. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG. The SOFA (Sepsis.related Organ Failure Assessment) score to describe organ dysfunction/failure On behalf of the Working Group on Sepsis Related Problems of the European Society of Intensive Care Medicine. Intensiv Care Med. 1996;22:707–710.
    1. Jones AE, Trzeciak S, Kline JA. The sequential organ failure assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation. Crit Care Med. 2009;37(5):1649–1654. doi: 10.1097/CCM.0b013e31819def97.
    1. Ferreira LF, Bota DP, Bross A, Melot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically Ill patients. JAMA. 2001;286(14):1754–58. doi: 10.1001/jama.286.14.1754.
    1. Bouch DC, Thompson JP. Severity scoring systems in the critically ill. Contin Educ Anaesth Crit Care Pain. 2008;8(5):181–185. doi: 10.1093/bjaceaccp/mkn033.
    1. Pandharipande PP, Shintani AK, Hagerman HE, St Jacques PJ, Rice TW, Sanders NW, Ware LB. Derivation and validation of Spo2/Fio2 ratio to impute for Pao2/Fio2 ratio in the respiratory component of the sequential organ failure assessment score. Crit Care Med. 2009;37(4):1317–21. doi: 10.1097/CCM.0b013e31819cefa9.
    1. Grissom CK, Brown SM, Kuttler KG, Boltax JP, Jones J, Jephson AR, Orme JF., Jr A modified sequential organ failure assessment (MSOFA) score for critical care triage. Disaster Med Public Health Prep. 2010;4(4):1–17. doi: 10.1001/dmp.2010.40.
    1. Acharya SP, Pradhan B, Marhatta MN. Application of “the sequential organ failure assessment (SOFA) score” in predicting outcome in ICU patients with SIRS. Kathmandu Univ Med J. 2007;5(20):475–83.
    1. Kaukonen K, Bailey M, Pilcher D, Cooper DJ, Bellomo R. Systemic Inflammatory Response Syndrome Criteria in Defining Severe Sepsis. NEJM. 2015;372:1–10.
    1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfield GD, Poll TV, Vincent JL, Angus DC. The third international consensus definitions for sepsis and septic shock (sepsis-3) JAMA. 2016;315(8):801–10. doi: 10.1001/jama.2016.0287.
    1. Kruisselbrink R, Kwizera A, Crowther M, Fox AR, O’Shea T, Nakibuuka J, Ssinabulya I, Nalyazi J, Bonner A, Devji T, Wong J, Cook D. Modified early warning score (MEWS) identifies critical illness among ward patients in a resource restricted setting in Kampala, Uganda: a prospective observational study. PLoS One. 2016;10:1–13.
    1. Kwizera A, Dunser M, Nakibuuka J. National intensive care unit bed capacity and ICU patient characteristics in a low income country. BMC Res Notes. 2012;5(475):1–6.
    1. Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, Rubenfield G, Kahn JM, Shankar-Hari M, Singer M, Deutschman CS, Escobar GJ, Angus DC. Assessment of clinical criteria for sepsis for the third international consensus definitions for sepsis and septic shock (sepsis-3) JAMA. 2016;315(8):762–74. doi: 10.1001/jama.2016.0288.
    1. Shankar-Hari M, Phillips GS, Levy ML, Seymour CW, Liu VX, Deutschman CS, Angus DC, Rubenfield GD, Singer M. Developing a NewDefinition and assessing New clinical criteria for septic shock for the third international consensus definitions for sepsis and septic shock (sepsis-3) JAMA. 2016;315(8):775–87. doi: 10.1001/jama.2016.0289.
    1. Vosylius S, Sipylaite J, Ivaskevicius J. Sequential organ failure assessment score as the determinant of outcome for patients with severe sepsis. Croat Med J. 2004;45(6):715–20.
    1. Moreno R, Vincent JL, Matos R, Mendonça A, Cantraine F. The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Working group on sepsis related problems of the ESICM. Intensive Care Med. 1999;25(7):686–96. doi: 10.1007/s001340050931.
    1. Minne L, Abu-Hanna A, de Jonge E. Evaluation of SOFA-based models for predicting mortality in the ICU: a systematic review. Crit Care. 2008;12(6):1–13.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera