Development and Validation of the Sequential Organ Failure Assessment (SOFA)-2 Score
Development and Validation of the Sequential Organ Failure Assessment (SOFA)-2 Score Manu Shankar-Hari, MD, PhD6; David Pilcher, MBBS7,8,9; Joana Berger-Estilita, MD, PhD10; Craig M. Coopersmith, MD11; Nicole P. Juffermans, MD, PhD12; John Laffey, MD, DSc13,14; Matti Reinikainen, MD, PhD15; Ary Serpa Neto, MD, MSc, PhD7,16,17; Miguel Tavares, MD18,19; Jean-François Timsit, MD, PhD20,21; Maria Del Pilar Arias Lopez, MD22,23; Nish Arulkumaran, PhD4; Diptesh Aryal, MD, PhD5,24; Elie Azoulay, MD, PhD25; Leo Anthony Celi, MD, MPH, MSc26,27,28; Dipayan Chaudhuri, MD, MSc29,30; Dylan De Lange, MD, PhD31; Jan De Waele, MD, PhD32; Claudia C. Dos Santos, MD, MSc33,34; Bin Du, MD35,36; Sharon Einav, MD, MSc37; Teresa Engelbrecht, BSc38; Fathima Fazla, MSc39; Ricard Ferrer, MD, PhD40; Stefano Finazzi, PhD41; Tomoko Fujii, MD, PhD42; Hayley B. Gershengorn, MD43; John D. Greene, MA44; Rashan Haniffa, MD, PhD45,46; Sicheng Hao, MSc26; Mohd Shahnaz Hasan, MBBS, MAnaes47; Steve Hollenberg, MD48; Mariachiara Ippolito, MD49; Christian Jung, MD, PhD50; Mikhail Kirov, MD, PhD51; Shigetaka Kobari, BS52; Inès Lakbar, MD, PhD53; Jeffrey Lipman, MBBCH, MD, DMed(Res)54,55; Vincent Liu, MD56; Xiaoli Liu, PhD26; Suzana M. Lobo, MD, PhD57; Demetrio Magatti, MSc41; Greg S. Martin, MD, MSc58; Barbara Metnitz, PhD59; Philipp Metnitz, MD, PhD60; Sheila N. Myatra, MD61; Simon Oczkowski, MD, MSc, MHSc62; José-Artur Paiva, MD, PhD63,64; Fathima Paruk, MD, PhD65; Pirkka T. Pekkarinen, MD, PhD66; Lise Piquilloud, MD, PhD67; Anssi Pölkki, MD, PhD68; Hallie C. Prescott, MD, MSc69; Annika Reintam Blaser, MD, PhD70,71; Ederlon Rezende, MD72; Chiara Robba, MD, PhD73,74; Bram Rochwerg, MD, MSc75; Stephane Ruckly, MSc20,21; Rasoul Samei, BSci41; Edward J. Schenck, MD, MS76; Paul Secombe, BMBS, MSc7,77; Cornelius Sendagire, MD5,78; Moses Siaw-Frimpong, MD79; Andrew J. Simpkin, MD80,81; Márcio Soares, MD, PhD5; Charlotte Summers, BM, PhD82; Wojciech Szczeklik, MD, PhD83; Jukka Takala, MD, PhD84; Shiro Tanaka, PhD52; Giovanni Tricella, PhD41; Jean-Louis Vincent, MD, PhD85; Julia Wendon, MBChB86; Fernando G. Zampieri, MD, PhD87; Andrew Rhodes, MB, BS, MD(Res)88; Rui Moreno, MD, PhD89,90,91 Abstract Importance Acute dysfunction of vital organs is the hallmark of critical illness. The Sequential Organ Failure Assessment (SOFA) score, the most widely adopted approach to describe organ dysfunction, has not been updated in 30 years and therefore may not appropriately capture current clinical practice and outcomes. 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. Torna alla lista ARTICOLI Vai all’articolo
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