Abstract 4366912: Utilizing Sequential Organ Failure Assessment score to Predict In-patient Mortality Among Patients Requiring Rapid Response Within 24 Hours of Admission

Abstract

Introduction: The Sequential Organ Failure Assessment (SOFA) score is a tool to predict mortality in the medical intensive care unit (MICU). Since SOFA was developed in septic shock patients, correlation with mortality in the cardiac intensive care unit (CICU) has varied. Hypothesis: We aimed to assess whether SOFA scores correlate with in-patient mortality among patients admitted to CICU or MICU following a rapid response team activation within 24 hours of admission. Methods: We conducted a multicenter retrospective cohort study of 763 patients who required rapid response team (RRT) activation for clinical decompensation within 24 hours of admission. The patients were grouped by level of care required following RRT (MICU, CICU, or medicine floor). Demographic and clinical variables were analyzed using analysis of variance and chi-square test, as appropriate. SOFA score and mortality were plotted as a simple logistic regression. Results: Of the 763 patients analyzed, 757 had reportable SOFA scores; the median age was 73 years; 396 (51.9%) were male. Simple logistic regression of SOFA score and in-patient mortality showed a positive correlation across the cohort (Figure 1 and 2). 185 (24.2%) patients were transferred to MICU, 57 (7.4%) patients were transferred to CICU, and 521 (68.2%) patients remained on the medical floors after RRT. A total of 164 deaths were recorded; 69 (42%) occurring in the MICU, 13 (8%) occurring in the CICU, and 82 (50%) with patients on the medical floor. Simple logistic regression of SOFA score and in-patient mortality by unit showed a positive correlation regardless of level of care following RRT (Figure 1 and 2). All correlations between SOFA score and mortality were statistically significant, regardless of patient level of care (Figure 3). Conclusions: SOFA score was positively correlated with in-hospital mortality across all levels of care among patients requiring RRT within 24 hours of admission and may be a useful score for predicting CICU mortality, in addition to MICU mortality. Additionally, patients with higher SOFA scores during early RRT activation might benefit from prompt acceptance to a critical care setting. Further studies are needed to assess which risk calculator may correlate best with mortality in the CICU and other clinical settings.