Severity of Illness Scoring System

1. SEQUENTIAL ORGAN FAILURE
ASSESSMENT SCORE

2. Introduction
 Severity of illness scoring systems – widely used in
critical care units.
 Purpose:
RCTs & Clinical Research - Comparability
Administrative purpose – Allocation of resources
ICU – Assessment of performance
Patients – Individual prognosis & guiding care

3. Types of Severity Scoring Systems
First Day Scoring Systems
APACHE (Acute Physiology & Chronic Health Condition)
SAPS (Simplified Acute Physiology Score)
MPM (Mortality Prediction Model)
Repetative Scoring Systems
OSF (Organ System Failure)
MODS (Multiple Organ Dysfunction Score)
SOFA (Sequential Organ Failure Asssessment)

4. SOFA – Historical Perspective
 1994 - “Sepsis” Related Organ Failure Assessment
(European Society of Intensive Care Medicine)
 Renamed to “Sequential” Organ Failure Assessment

5. SOFA - Components
Neurological GCS
Cardiovascular MAP
Vasopressor Use
Renal Serum Creatine
Urine Output
Respiratory Pao2/Fio2 ratio
Mecahanical Ventilation
Hematological Platelet Count
Hepatic Serum Bilirubin

6. SOFA - Components

7. SOFA - Components
Neurological GCS
Cardiovascular MAP
Vasopressor Use
Renal Serum Creatine
Urine Output
Respiratory Pao2/Fio2 ratio
Mecahanical Ventilation
Hematological Platelet Count
Hepatic Serum Bilirubin

8. SOFA - Validation
 Valided for both medical & surgical ICU patients.
(Vincent JL, Moreno R. Clinical review: scoring systems in the critically ill. Crit
Care. 2010;14(2):207.)
 Maximum total SOFA > 15 - mortality rate of 90%.
(Vincent JL, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter PM, et al.
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)

9. SOFA - Validation
 Increase during the first 48 hours in the ICU,
independent of the initial score - mortality rate of at
least 50%; decrease - 27%.
(Ferreira FL, 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):1754-8.)
 100% mortality in patients with >60 years, a total
maximum SOFA >13 on any of the first 5 days of ICU
admission, minimum SOFA >10 at all times, and a
positive or unchanged SOFA trend over the first 5 days
of ICU admission.
(Cabre L, Mancebo J, Solsona JF, Saura P, Gich I, Blanch L, et al. Multicenter study of the
multiple organ dysfunction syndrome in intensive care units: the usefulness of
Sequential Organ Failure Assessment scores in decision making. Intensive Care Med.
2005;31(7):927-33)

10. SOFA – Application to Cardiac Surgical
Patients
 Observational cohort study.
 Adult cardiac surgical ICU.
 218 patients requiring ICU stay >96 hours.
 Conclusion – Reliable & onjective description of ongoing
course of organ impairment after cardiac surgery.
(Ceriani R, Mazzoni M, Bortone F, Gandini S, Solinas C, Susini G, et al.
Application of the sequential organ failure assessment score to cardiac surgical
patients. Chest. 2003;123(4):1229-39.)

11. THANK YOU