SOFA score ‘inadequate’ for triaging critically ill patients with COVID-19
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When predicting mortality in hospitalized patients with COVID-19-related pneumonia, researchers found that the Sequential Organ Failure Assessment, or SOFA, score was “significantly inferior to simply using age.”
The findings were recently published in JAMA.
In the event of a COVID-19 surge, hospitals may need to triage critically ill patients to ensure that those with a higher probability of short-term survival receive mechanical ventilation. A previous survey published in Annals of Internal Medicine identified 26 different COVID-19 triage policies in U.S. hospitals. Among them, 20 incorporated the SOFA score.
Robert A. Raschke, MD, a clinical professor of medicine and biomedical informatics at the University of Arizona College of Medicine in Phoenix, and colleagues conducted a retrospective study to determine the discriminant accuracy of the SOFA score in predicting mortality among patients with COVID-19-related pneumonia who require mechanical ventilation.
The SOFA score was originally designed to assess the health of patients with sepsis, according to the researchers. It ranks six different organ systems on a scale of zero to four points. The overall SOFA score ranges from zero to 24 points, with higher scores indicating worse organ function, according to the researchers.
The final analysis included 675 patients who were admitted to one of 18 ICUs in the southwestern United States between March 1, 2020, and August 31, 2020. All patients were aged 18 years or older and received oxygen therapy for at least 4 hours before undergoing endotracheal intubation.
Overall, the median SOFA score among patients was six (interquartile range, 4 to 8). In most patients, 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%), coagulation (94.2%), cardiovascular system (95.1%) and hepatobiliary system (96.5%). Nearly 60% of patients died or were discharged to hospice care.
Raschke and colleagues reported that the accuracy of the SOFA score was “poor,” with an area under the receiver operating characteristic curve of 0.59 (95% CI, 0.55-0.63) vs. 0.66 (95% CI, 0.62-0.70) for age (P = .02).
“The SOFA score possesses inadequate discriminant accuracy to be used for ventilator triage of COVID-19 patients,” the researchers concluded. “A better option is needed that incorporates variables specifically related to mortality in patients with COVID-19 pneumonia requiring mechanical ventilation.”
References:
- Antommaria AHM, et al. Ann Intern Med. 2021;doi:10.7326/M20-1738.
- Raschke RA, et al. JAMA. 2021;doi:10.1001/jama.2021.1545.
Perspective
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Manu Jain, MD
This research letter looks at a SOFA score as a way to prognosticate 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 do not think that this is robust way to prognosticate the survival of people with COVID-19.
The SOFA score has some utility in different situations, but it is not often used as a clinical tool, especially for individual prognostication; it is typically used as a research tool in clinical trials. Even when 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 really is not even used in the disease that it was developed for with regard to individual clinical decision making. In my opinion, it would not be useful in COVID-19 infection and should not be used for making decisions for an individual patient.
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