Acute Crit Care.  2020 Aug;35(3):169-178. 10.4266/acc.2020.00143.

Sequential Organ Failure Assessment score as a predictor of mortality in ventilated patients with multidrug-resistant bacteremia

• Oh Y
• Roh J
• Lee J
• Chung HS
• Lee K
• Lee MK

• KMID: 2506096
• DOI: http://doi.org/10.4266/acc.2020.00143

Abstract

Background
The occurrence of multidrug-resistant (MDR) bacteremia in ventilated patients may be associated with a high mortality rate. We evaluated whether Sequential Organ Failure Assessment (SOFA) score on the day of bacteremia could predict 90-day mortality in these patients.
Methods
Data were obtained retrospectively from 202 patients (male, 60.4%; median age, 64 years) hospitalized at a single university-affiliated tertiary care hospital. All adult patients who had were ventilated and had one of the following six MDR bacteremias between March 2011 and February 2018 were enrolled: methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase-producing Gram-negative bacteria (Escherichia coli and Klebsiella pneumonia), carbapenem-resistant Gram-negative rods (Acinetobacter baumannii and Pseudomonas aeruginosa), or vancomycin-resistant Enterococcus faecium.
Results
The overall 90-day mortality rate after the day of bacteremia was 59.9%. The areas under the receiver operating characteristic curves for the SOFA and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were 0.732 (95% confidence interval [CI], 0.666 to 0.792; P < 0.001) and 0.662 (95% CI, 0.593 to 0.727; P < 0.001), respectively, with no difference between the two (P = 0.059). Also, the cutoff value of the SOFA score was 9 (based on Youden’s index). Multivariate Cox regression analysis showed that this cut-off value was significantly associated with higher mortality rate (hazard ratio, 2.886; 95% CI, 1.946 to 4.221;P < 0.001).
Conclusions
SOFA score measured on the day of bacteremia may be a useful prognostic indicator of 90-day mortality in ventilated patients with MDR bacteremia.

Keyword

bacteremia; intensive care unit; prognosis

Figure

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  Figure 1. Flowchart of recruited and enrolled study participants. ICU: intensive care unit; MDR: multidrug-resistant.

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  Figure 2. Kaplan-Meier analysis of 90-day survival after the day of bacteremia according to Sequential Organ Failure Assessment (SOFA) score cut-off values in (A) all enrolled patients, (B) Gram-positive patients, and (C) Gram-negative patients. Differences between patients above and below the cut-offs were (A) 39.39% (P<0.001), (B) 16.53% (P<0.001), and (C) 22.69% (P<0.001) by log-rank tests.

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  Figure 3. Receiver operating characteristic (ROC) curves for Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores for predicting 90-day mortality after the day of bacteremia in (A) all enrolled patients, (B) Gram-positive patients, and (C) Gram-negative patients. (A) In all patients, the area under the ROC curves for the SOFA and APACHE II scores were 0.732 (95% confidence interval [CI], 0.666–0.792; P<0.001) and 0.662 (95% CI, 0.593–0.727; P<0.001), respectively, with no difference between the two (P=0.059). (B) In patients with Gram-positive bacteremia, the AUCs for the SOFA and APACHE II scores were 0.733 (95% CI, 0.636–0.817; P<0.001) and 0.701 (95% CI, 0.601–0.788; P<0.001), respectively, with no difference between the two (P=0.572). (C) In patients with Gram-negative bacteremia, the AUCs for the SOFA and APACHE II scores were 0.720 (95% CI, 0.624–0.803; P<0.001) and 0.622 (95% CI, 0.523–0.714; P<0.001), respectively. The AUC for SOFA score was significantly higher than the AUC for APACHE II score (P=0.037).

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