J Korean Med Sci.  2023 Dec;38(50):e418. 10.3346/jkms.2023.38.e418.

Modified Cardiovascular Sequential Organ Failure Assessment Score in Sepsis: External Validation in Intensive Care Unit Patients

• Ko BS
• Ryoo SM
• Han E
• Chang H
• Yune CJ
• Lee HJ
• Suh GJ
• Choi SH
• Chung SP
• Lim TH
• Kim WY
• Sohn JW
• Jeong MA
• Hwang SY
• Shin TG
• Kim K
• oboKSS

• KMID: 2549959
• DOI: http://doi.org/10.3346/jkms.2023.38.e418

Abstract

Background
There is a need to update the cardiovascular (CV) Sequential Organ Failure Assessment (SOFA) score to reflect the current practice in sepsis. We previously proposed the modified CV SOFA score from data on blood pressure, norepinephrine equivalent dose, and lactate as gathered from emergency departments. In this study, we externally validated the modified CV SOFA score in multicenter intensive care unit (ICU) patients.
Methods
A multicenter retrospective observational study was conducted on ICU patients at six hospitals in Korea. We included adult patients with sepsis who were admitted to ICUs. We compared the prognostic performance of the modified CV/total SOFA score and the original CV/total SOFA score in predicting 28-day mortality. Discrimination and calibration were evaluated using the area under the receiver operating characteristic curve (AUROC) and the calibration curve, respectively.
Results
We analyzed 1,015 ICU patients with sepsis. In overall patients, the 28-day mortality rate was 31.2%. The predictive validity of the modified CV SOFA (AUROC, 0.712; 95% confidence interval [CI], 0.677–0.746; P < 0.001) was significantly higher than that of the original CV SOFA (AUROC, 0.644; 95% CI, 0.611–0.677). The predictive validity of modified total SOFA score for 28-day mortality was significantly higher than that of the original total SOFA (AUROC, 0.747 vs. 0.730; 95% CI, 0.715–0.779; P = 0.002). The calibration curve of the original CV SOFA for 28-day mortality showed poor calibration. In contrast, the calibration curve of the modified CV SOFA for 28-day mortality showed good calibration.
Conclusion
In patients with sepsis in the ICU, the modified SOFA score performed better than the original SOFA score in predicting 28-day mortality.

Keyword

Sepsis; Mortality; Organ Dysfunction Scores; Severity of Illness Index

Figure

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  Fig. 1 Distribution and 28-day mortality according to original and modified cardiovascular/total SOFA scores. Bar graphs represent the number of patients, and points with error bars indicate 28-day mortality with 95% confidence intervals.SOFA = Sequential Organ Failure Assessment.

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  Fig. 2 Receiver operating characteristic curves for predicting 28-day mortality in the original and modified cardiovascular/total SOFA.SOFA = Sequential Organ Failure Assessment, AUC = area under the curve, CI = confidence interval.

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  Fig. 3 Calibration plots for 28-day mortality between the original and modified cardiovascular/total SOFA.SOFA = Sequential Organ Failure Assessment.

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