Development and Validation of the Sequential Organ Failure Assessment (SOFA)-2 Score.
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Ошибки и ограничения
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Ranzani Otavio T, Singer Mervyn, Salluh Jorge I F, Shankar-Hari Manu, Pilcher David, Berger-Estilita Joana, Coopersmith Craig M, Juffermans Nicole P, Laffey John, Reinikainen Matti, Neto Ary Serpa, Tavares Miguel, Timsit Jean-François, Arias Lopez Maria Del Pilar, Arulkumaran Nish, Aryal Diptesh, Azoulay Elie, Celi Leo Anthony, Chaudhuri Dipayan, De Lange Dylan, De Waele Jan, Dos Santos Claudia C, Du Bin, Einav Sharon, Engelbrecht Teresa, Fazla Fathima, Ferrer Ricard, Finazzi Stefano, Fujii Tomoko, Gershengorn Hayley B, Greene John D, Haniffa Rashan, Hao Sicheng, Hasan Mohd Shahnaz, Hollenberg Steve, Ippolito Mariachiara, Jung Christian, Kirov Mikhail, Kobari Shigetaka, Lakbar Inès, Lipman Jeffrey, Liu Vincent, Liu Xiaoli, Lobo Suzana M, Magatti Demetrio, Martin Greg S, Metnitz Barbara, Metnitz Philipp, Myatra Sheila N, Oczkowski Simon, Paiva José-Artur, Paruk Fathima, Pekkarinen Pirkka T, Piquilloud Lise, Pölkki Anssi, Prescott Hallie C, Blaser Annika Reintam, Rezende Ederlon, Robba Chiara, Rochwerg Bram, Ruckly Stephane, Samei Rasoul, Schenck Edward J, Secombe Paul, Sendagire Cornelius, Siaw-Frimpong Moses, Simpkin Andrew J, Soares Márcio, Summers Charlotte, Szczeklik Wojciech, Takala Jukka, Tanaka Shiro, Tricella Giovanni, Vincent Jean-Louis, Wendon Julia, Zampieri Fernando G, Rhodes Andrew, Moreno Rui
Аннотация
OBJECTIVES: To inform the data-driven component of an updated score (SOFA-2) in varied geographical and resource settings (stages 6-8) after expert input via a modified Delphi process (stages 1-5).
DESIGN, SETTING, AND PARTICIPANTS: A federated analysis was performed on data collected from adult patients admitted to 1319 intensive care units (ICUs) in 9 countries (Australia, Austria, Brazil, France, Italy, Japan, Nepal, New Zealand, United States) between 2014 and 2023. Four representative multicenter cohorts containing data from 2 098 356 patients were used for data-driven score development and internal validation. External validation was performed on 6 cohorts containing data from 1 241 114 patients.
MAIN OUTCOMES AND MEASURES: Content validity for organ dysfunction identified through the modified Delphi process should be reflected by predictive validity using the area under the receiver operating characteristic (AUROC) curve of the score measured on the first ICU day (higher scores indicate worse organ dysfunction).
RESULTS: Of 3.34 million patient encounters, 270 108 (8.1%) died in the ICU (range, 4.5% to 20.5% across the 10 cohorts). SOFA-2 modified the 6 organ systems of the original SOFA score (brain, respiratory, cardiovascular, liver, kidney, hemostasis), including new variables and revised thresholds that better describe the organ dysfunction distribution from 0 to 4 points and their associated mortality (SOFA-2 AUROC, 0.79; 95% CI, 0.76-0.81; SOFA-1 AUROC, 0.77; 95% CI, 0.74-0.81). Evaluation of sequential SOFA-2 data from ICU day 1 to day 7 maintained its predictive validity. Insufficient data and lack of content validity precluded incorporation of gastrointestinal and immune dysfunction scores into SOFA-2.
CONCLUSIONS AND RELEVANCE: The SOFA-2 score, updated to include contemporary organ support treatments and new score thresholds, describes organ dysfunction in a large, geographically and socioeconomically diverse population of critically ill adults.