Akshay Hiryur Manjunatha Swamy1, Girish Bandigowdanahalli Kumararadhya2, Srinivas Hebbal Thammaiah3, Nanda Karikere Siddagangaiah4, Shiva Kumar K.G.5
BACKGROUND
Multiple organ dysfunction syndrome (MODS) has recently been considered as a
defining syndrome of sepsis and is responsible for a high mortality rate among the
patients in the intensive care units (ICUs). Prognostication of the ICU patients is
an integral part of the management of the critically ill patients and many scoring
systems, for that matter, have been devised and compared for their efficiency at
predicting mortality. This study was conducted to evaluate and compare the
validity of sequential organ failure assessment (SOFA), acute physiology and
chronic health evaluation (APACHE II) and APACHE IV as mortality predictors in
intensive care unit (ICU) patients suffering from MODS in sepsis.
METHODS
Hundred patients diagnosed with MODS in sepsis were carefully examined,
followed by relevant laboratory investigations. The SOFA score was calculated
daily, and the APACHE II and IV scores were calculated on the day of admission.
The scores were further compared among the survivors and the non-survivors,
followed by receiver operating characteristic (ROC) curve analysis of the SOFA D1,
D2, and D3 and the APACHE II and IV scores to estimate their capability of
mortality prediction.
RESULTS
The means of the APACHE II, IV and SOFA D1 were 16.57 ± 6.49, 71.91 ± 16.19
and 8.75 ± 2.20, respectively. There was a statistically significant difference in the
mean APACHE II scores (14.23 ± 5.20 vs. 21.12 ± 6.38) and the mean APACHE
IV scores (67.27 ± 13.21 vs. 80.91 ± 17.77) in the survivors and the nonsurvivors.
A statistically significant difference was also evident in the mean ages
of the survivors and the non-survivors (52.82 ± 14.67 years vs. 63.25 ± 16.98
years). The SOFA score was high among the non-survivors than the survivors right
from day-1 (10.24 ± 2.08 vs. 7.98 ± 1.86) to day-20 (15.00 ± 0.00 vs. 3.14 ±
0.38). Furthermore, ROC analysis showed that the best discrimination was
provided by SOFA D3 followed by the APACHE II and SOFA D1 scores, with
APACHE IV score showing the least.
CONCLUSIONS
SOFA score on day 3 provides the best mortality prediction in patients with MODS
in sepsis, as compared to APACHE II and IV scores.
