Sequential Organ Failure Assessment Score(SOFA) As a Prognostic Marker in Patients with Sepsis in An Intensive care Unit of A Tertiary Hospital.” – A One Year Hospital Based Cross-Sectional Study

Abstract

Background and objectives Sepsis with multiple organ dysfunction syndrome (MODS) is a common cause of Intensive Care Unit (ICU) mortality and morbidity. Early start of appropriate effective antimicrobial therapy is important for a favourable outcome in the patient with sepsis. Cultures and serology are available only after 24 to 48 hours. In the crucial hours the physician has to depend on clinical symptoms and laboratory parameters to aid in diagnosis and management. An efficient predictor of prognosis of sepsis is required to assess morbidity and mortality of this condition. There are many scoring systems to determine and predict the mortality of sepsis, Such as GLASGOW COMA SCALE, SAPS II, APACHE, SOFA score. Currently available outcome prediction models such as the APACHE [Acute Physiology and Chronic Health Evaluation], SAPS [simplified acute physiology score], and MPM [mortality probability model’s systems) calculate a prediction on values taken within the first 24 hours of an ICU stay. In SOFA score, daily scoring of individual and composite scoring is possible. Higher sofa score is associated with worst outcome and also response of organ dysfunction to therapy can be followed over time. The Sequential Organ Failure Assessment score (SOFA score) is used to track a patient's status during the stay in an intensive care unit (ICU). The SOFA score is a scoring system to determine the extent of a person's organ dysfunction or rate of failure.93 This score is based on six different parameters, one each for the respiratory, cardiovascular, hepatic, coagulation, renal and neurological systems. The objectives of present study were to assess the predictive value of sofa score at 0 and 48 hours with outcome in sepsis patients with multiorgan dysfunction. Methods The present cross-sectional study was conducted on patients with Sepsis admitted in Intensive care unit of KLES Dr Prabhakar Kore Hospital and Medical Research Centre, Belagavi from Jan 2016 to Dec 2016. Relevant data was collected by a detailed interview with patient or the attender, clinical examination, lab reports. Patient were enrolled as sepsis based on: Inflammatory response syndrome, and severe sepsis criteria as per American college of chest physicians and society of critical care medicine. They were then scored according to the SOFA score at admission and after 48 hours. These findings were noted on a predesigned and pretested proforma.The comparison of categorical data was done using Chi-square test or Fisher’s exact test. Continuous data was compared using independent sample‘t’ test. In case of more than two means one-way ANOVA was used to compare the data. ROC analysis was also done to predict the sensitivity and specificity of score. A probability value (‘p’ value) of less than or equal to 0.05 was considered as statistically significant. Results: We enrolled 130 subjects in our study, out of which 86 were males and 44 were females. We observed that 40% subjects in our study were in the age group of 40-59 years. Diabetes (60%) and hypertension (40.77%) were the most common co morbidity and pneumonia (26.15%) and urosepsis (19.23%) were the leading cause of sepsis in our study group. We also observed in our study that, the mean sofa score for 0 hours (admission) for survivors was 5.39 and non-survivor was 10.85 whereas at 48 hours the mean sofa score for survivor was 4.16 and non-survivor was 12.83 respectively. We also observed that patient with mean sofa score at admission of 2.95 had a stay of less than 7 days, with 5.69 had a stay of 8-15 days and those with 7.5 had a stay of above 15 days. At a mean score of 10 there was eventual mortality, while a mean score of 14.8 had worst outcome in the form of mortality within 24 hours of admission., Similarly cases with mean sofa score of 1.26 at 48 hours had a stay of less than 7 days, with 4.69 had a stay of 8-15 days and those above 8.20 had a stay of above 15 days. Patients with a score of 12.83 had mortality. On plotting ROC curve, we observed that the optimum cut off value for SOFA score for predicting mortality both at 0 and 48 hours was 7.5. The sensitivity and specificity to predict mortality at 0 hours was 87.8% and 75.3% respectively while at 48 hours sensitivity was 100% and specificity was 83.1%. The AUC obtained for ROC curve was 0.920 and 0.971 at admission and 48 hours respectively, suggesting SOFA score at 48 hours as a better predictive index for outcome. Conclusion In our study population, Diabetes and hypertension were the most common co morbidity, pneumonia and urosepsis were the leading cause of sepsis.There was a higher percentage of mortality and longer duration of stay with increasing SOFA scores. Through statistical analysis we reached to a cut off value of 7.5 for predicting the outcome of patients. The sensitivity and specificity of score at 0 hours was found 87.8% and 75.3% while for 48 hours was 100% and specificity was 83.1%, thus 48 hours score was more specific and sensitive for prediction of outcome. Similarly, we found that AUC for 0 hours and 48 hours was 0.920 and 0.971 respectively, thus score at 48 hours was better predictor as compared to score at admission