Damian McNamara

February 01, 2017

HONOLULU — The Sequential Organ Failure Assessment (SOFA) score provides an accurate assessment of sepsis and septic shock in patients admitted to the intensive care unit (ICU), according to a large study conducted in Australia and New Zealand.

The research validates the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) guidelines, which indicate that SOFA is more likely to predict in-hospital mortality than the quick SOFA (qSOFA) score or systemic inflammatory response syndrome (SIRS) scores in this patient population.

"You can use the SOFA score to diagnose sepsis in the ICU. Our take-home message is that when you have a patient in the intensive care setting with an infection and you suspect sepsis, a change in SOFA score of 2 or more points is associated with an increased risk for mortality," said Eamon Raith, MBBS, from the University of Adelaide in Australia.

The Sepsis-3 guidelines were developed using data from patients in multiple centers in the United States and one site in Germany. "We didn't know if these data would apply" in Australia and New Zealand, he told Medscape Medical News.

To establish whether they would, the researcher team retrospectively examined 184,875 patients with an infection-related primary admission diagnosis in 182 Australian and New Zealand ICUs from 2000 to 2015. Dr Raith presented the results here at the Society of Critical Care Medicine 46th Critical Care Congress. Full details of the study were published in JAMA (2017;317:290-300).

The researchers applied SOFA, qSOFA, and SIRS criteria to clinical data collected in the first 24 hours of ICU admission, and then gauged the ability of each scoring system to predict in-hospital mortality. A secondary measure was a composite of in-hospital mortality and the rate of stays in the ICU of at least 3 days. They compared results using the area under the receiver operating characteristic curve.

Table. Predictive Ability of the Scoring Systems

Scoring System In-Hospital Mortality Composite of In-Hospital Mortality and Length of ICU Stay
SOFA 0.753 0.736
qSOFA 0.607 0.606
SIRS 0.607 0.609


"These findings suggest that SIRS criteria and qSOFA may have limited utility for predicting mortality in an ICU setting," Dr Raith and his colleagues explain in their published study.

The design of this study — a large population examined over an extended period of time — is important because it "validates the findings of Sepsis-3 outside of the United States, and it validates the findings of Sepsis-3 in a much bigger database than was originally studied," said Craig Coopersmith, MD, from the Emory University School of Medicine in Atlanta.

We can apply this now on a much more global scale.

"We're lucky in Australia. Through the Australian and New Zealand Intensive Care Society, we have access to the Adult Patient Database. We had such large numbers that we could say, yes, the SOFA score is better in the ICU than SIRS or qSOFA," Dr Raith said. "It validates the American data, and it also means we can apply this now on a much more global scale."

"Having a SOFA score of 2 or higher successfully discriminated outcomes across a range of illness severity," Dr Coopersmith told Medscape Medical News.

"There was a lot of interest in this presentation and the Freund paper" (JAMA. 2017;317:301-308) at the congress, because both sought to validate Sepsis-3 — one in the ICU and the other in the emergency department, he explained. The Freund report showed that, unlike in the ICU, qSOFA is an effective predictor of outcome in the emergency department, he added.

"This is the first time we have a definition of sepsis and diagnostic criteria that are linked to mortality," said Dr Raith. It is "part of a movement toward a more strictly defined definition of sepsis."

Going forward, the researchers plan to evaluate the same dataset to look at trends in sepsis outcomes and to predict what the clinical picture of sepsis could look like in 2025, he explained. "We're predicting there will be more patients in the ICU with sepsis but there will be better survival," he said.

Dr Raith has disclosed no relevant financial relationships. Dr Coopersmith was an author of the SEPSIS-3 guidelines.

Society of Critical Care Medicine (SCCM) 46th Critical Care Congress. Presented January 24, 2017.


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