Feasibility of the Modified Sequential Organ Function Assessment Score in a Resource-constrained Setting: a Prospective Observational Study

Overview

Journal BMC Anesthesiol

Publisher Biomed Central

Specialty Anesthesiology

Date 2017 Jan 27

PMID 28122489

Citations 21

Authors

Cornelius Sendagire

Michael S Lipnick

Sam Kizito

Rebecca Kruisselbrink

Daniel Obua

Joseph Ejoku

Lameck Ssemogerere

Jane Nakibuuka

Arthur Kwizera

Affiliations

Soon will be listed here.

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 PaO/FiO ratio with SPO/FiO. 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.

Citing Articles

External validation of a modified cardiovascular sequential organ failure assessment score in patients with suspected infection using the MIMIC-IV database.

Hwang S, Kim I, Ko B, Ryoo S, Han E, Lee H PLoS One. 2024; 19(11):e0312185.

PMID: 39531422 PMC: 11556716. DOI: 10.1371/journal.pone.0312185.

Characteristics and outcomes of patients admitted to intensive care units in Uganda: a descriptive nationwide multicentre prospective study.

Atumanya P, Agaba P, Mukisa J, Nakibuuka J, Kwizera A, Sendagire C Sci Rep. 2024; 14(1):9963.

PMID: 38693185 PMC: 11063042. DOI: 10.1038/s41598-024-59031-5.

Derivation and validation of a screening tool for stroke-associated sepsis.

Stosser S, Kleusch L, Schenk A, Schmid M, Petzold G Neurol Res Pract. 2023; 5(1):32.

PMID: 37438794 PMC: 10339529. DOI: 10.1186/s42466-023-00258-4.

Results from the first audit of an intensive care unit in Botswana.

Milan A, Cox M, Molebatsi K South Afr J Crit Care. 2023; 36(1).

PMID: 37234946 PMC: 10208596. DOI: 10.7196/SAJCC.2020.v36i1.395.

The Diagnostic Value of Cerebrospinal Fluid Lactate for Detection of Sepsis in Community-Acquired Bacterial Meningitis.

Nitsch L, Ehrentraut S, Grobe-Einsler M, Bode F, Banat M, Schneider M Diagnostics (Basel). 2023; 13(7).

PMID: 37046531 PMC: 10093535. DOI: 10.3390/diagnostics13071313.

References

Adhikari N, Fowler R, Bhagwanjee S, Rubenfeld G . Critical care and the global burden of critical illness in adults. Lancet. 2010; 376(9749):1339-46. PMC: 7136988. DOI: 10.1016/S0140-6736(10)60446-1. View

Moreno R, Vincent J, Matos R, Mendonca A, Cantraine F, Thijs L . 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. View

Fowler R, Adhikari N, Bhagwanjee S . Clinical review: critical care in the global context--disparities in burden of illness, access, and economics. Crit Care. 2008; 12(5):225. PMC: 2592728. DOI: 10.1186/cc6984. View

Pandharipande P, Shintani A, Hagerman H, St Jacques P, Rice T, Sanders N . 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. PMC: 3776410. DOI: 10.1097/CCM.0b013e31819cefa9. View

Kaukonen K, Bailey M, Pilcher D, Cooper D, Bellomo R . Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med. 2015; 372(17):1629-38. DOI: 10.1056/NEJMoa1415236. View

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):R161. PMC: 2646326. DOI: 10.1186/cc7160. View

Kruisselbrink R, Kwizera A, Crowther M, Fox-Robichaud A, OShea T, Nakibuuka J . 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; 11(3):e0151408. PMC: 4795640. DOI: 10.1371/journal.pone.0151408. View

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. PMC: 3470976. DOI: 10.1186/1756-0500-5-475. View

Vincent J, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter P . 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. View

10.

Jones A, Trzeciak S, Kline J . 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):1649-54. PMC: 2703722. DOI: 10.1097/CCM.0b013e31819def97. View

11.

Acharya S, Pradhan B, Marhatta M . Application of "the Sequential Organ Failure Assessment (SOFA) score" in predicting outcome in ICU patients with SIRS. Kathmandu Univ Med J (KUMJ). 2008; 5(4):475-83. View

12.

Seymour C, Liu V, Iwashyna T, Brunkhorst F, Rea T, Scherag A . 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. PMC: 5433435. DOI: 10.1001/jama.2016.0288. View

13.

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. View

14.

Grissom C, Brown S, Kuttler K, Boltax J, Jones J, Jephson A . A modified sequential organ failure assessment score for critical care triage. Disaster Med Public Health Prep. 2010; 4(4):277-84. PMC: 3811929. DOI: 10.1001/dmp.2010.40. View

15.

Shankar-Hari M, Phillips G, Levy M, Seymour C, Liu V, Deutschman C . Developing a New Definition 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. PMC: 4910392. DOI: 10.1001/jama.2016.0289. View

16.

Dunser M, Baelani I, Ganbold L . A review and analysis of intensive care medicine in the least developed countries. Crit Care Med. 2006; 34(4):1234-42. DOI: 10.1097/01.CCM.0000208360.70835.87. View

17.

Vincent J, Moreno R, Takala J, Willatts S, de Mendonca A, Bruining H . 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. Intensive Care Med. 1996; 22(7):707-10. DOI: 10.1007/BF01709751. View

18.

Ferreira F, Bota D, Bross A, Melot C, Vincent J . Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001; 286(14):1754-8. DOI: 10.1001/jama.286.14.1754. View

19.

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View

20.

Murthy S, Wunsch H . Clinical review: International comparisons in critical care - lessons learned. Crit Care. 2012; 16(2):218. PMC: 3568952. DOI: 10.1186/cc11140. View