Infectious Disease

The SOFA rating is “inadequate” to look at critically sick sufferers with COVID-19

February 26, 2021

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When predicting mortality in hospitalized patients with COVID-19-related pneumonia, researchers found that the Sequential Organ Failure Assessment (SOFA) score was “significantly worse than just using age.”

The results were recently published in JAMA.

Source: Raschke RA et al. JAMA. 2021; doi: 10.1001 / jama.2021.1545.

In the event of a spike in COVID-19, hospitals may need to screen critically ill patients to ensure those with a higher chance of short-term survival are receiving mechanical ventilation. An earlier survey published in Annals of Internal Medicine identified 26 different COVID-19 triage guidelines in US hospitals. Among them, 20 received the SOFA score.

Robert A. Raschke, MD, A clinical professor of medicine and biomedical informatics at the College of Medicine at the University of Arizona at Phoenix and colleagues conducted a retrospective study to determine the discriminant accuracy of the SOFA score in predicting mortality in patients with COVID-19-related pneumonia, who need mechanical ventilation.

The SOFA score was originally developed to assess the health of patients with sepsis, the researchers said. It classifies six different organ systems on a scale from zero to four points. The SOFA total score ranges from zero to 24 points, with higher scores indicating poorer organ function, according to the researchers.

The final analysis included 675 patients enrolled in one of 18 intensive care units in the American Southwest between March 1, 2020 and August 31, 2020. All patients were at least 18 years old and received oxygen therapy endotracheal intubation for at least 4 hours prior to treatment.

Overall, the mean SOFA value in the patients was six (interquartile range 4 to 8). For most patients, the SOFA subscores were three to four for the respiratory system (83.5%) and zero to one for the renal system (72.1%), central nervous system (78.5%), and coagulation (94.2 %) and the cardiovascular system (95.1%)%) and the hepatobiliary system (96.5%). Almost 60% of the patients died or were discharged into hospice care.

Raschke and colleagues reported that the accuracy of the SOFA score was “poor”, with an area under the receiver’s operating curve of 0.59 (95% CI, 0.55-0.63) versus 0.66 (95% CI , 0.62-0.70) for age (P = 0.02).

“The SOFA score has insufficient discriminant accuracy to be used for ventilation triage of COVID-19 patients,” the researchers concluded. “A better option is needed that takes into account variables specifically related to mortality in patients with COVID-19 pneumonia that require mechanical ventilation.”

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Manu Jain, MD)

Manu Jain, MD

In this research letter, a SOFA score is viewed as a way of predicting people with COVID-19 infection. The score is usually used in sepsis or septic shock. While COVID-19 can lead to critical illness, it is not the same as septic shock. So I don’t think this is a robust way to predict the survival of people with COVID-19.

The SOFA score is useful in various situations but is not widely used as a clinical tool, especially for individual prognosis. It is usually used as a research tool in clinical trials. Even if we have a patient with sepsis or septic shock, we do not make decisions about aggressive care or withholding care based on this score. So it is not even used on the disease for which it was designed with individual clinical decision-making in mind. In my opinion, it would not be useful with COVID-19 infection and should not be used to make decisions for an individual patient.

Manu Jain, MD

Peer Perspective Board member of the Healio Primary Care Professor of Medicine (Lung and Critical Care) and Pediatrics at the Feinberg School of Medicine at Northwestern University

Disclosure: Jain does not report any relevant financial information.

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