Does mid-regional pro-adrenomedullin (MR-proADM) improve the sequential organ failure assessment-score (SOFA score) for mortality-prediction in patients with acute infections? Results of a prospective observational study

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Ellen Haag ◽  
Claudia Gregoriano ◽  
Alexandra Molitor ◽  
Milena Kloter ◽  
Alexander Kutz ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sofa Score ◽  
Predictive Value ◽  
Acute Infection ◽  
Mortality Prediction ◽  
P Value ◽  
Assessment Score ◽  
Failure Assessment

Abstract Objectives Risk stratification in patients with infection is usually based on the Sequential Organ Failure Assessment-Score (SOFA score). Our aim was to investigate whether the vasoactive peptide mid-regional pro-adrenomedullin (MR-proADM) improves the predictive value of the SOFA score for 30-day mortality in patients with acute infection presenting to the emergency department (ED). Methods This secondary analysis of the prospective observational TRIAGE study included 657 patients with infection. The SOFA score, MR-proADM, and traditional inflammation markers were all measured at time of admission. Associations of admission parameters and 30-day mortality were investigated by measures of logistic regression, discrimination analyses, net reclassification index (NRI), and integrated discrimination index (IDI). Results MR-proADM values were higher in non-survivors compared with survivors (4.5 ± 3.5 nmol/L vs. 1.7 ± 1.8 nmol/L) with an adjusted odds ratio of 26.6 (95% CI 3.92 to 180.61, p=0.001) per 1 nmol/L increase in admission MR-proADM levels and an area under the receiver operator curve (AUC) of 0.86. While the SOFA score alone revealed an AUC of 0.81, adding MR-proADM further improved discrimination (AUC 0.87) and classification within predefined risk categories (NRI 0.075, p-value <0.05). An admission MR-proADM threshold of 1.75 nmol/L provided the best prognostic accuracy for 30-day mortality; with a sensitivity of 81% and a specificity of 75%, and a negative predictive value of 98%. Conclusions MR-proADM improved the mortality risk stratification in patients with infection presenting to the ED beyond SOFA score alone and may further improve initial therapeutic site-of-care decisions. Trial registration ClinicalTrials.gov NCT01768494. Registered January 15, 2013.

scholarly journals Predictors of maternal outcome in women on mechanical ventilation in an obstetric intensive care unit: an observational study

2019 ◽  
Vol 8 (2) ◽  
pp. 721
Author(s):  
Tanu Soni ◽  
Priyadarshini Tiwari
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Observational Study ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sofa Score ◽  
Coagulation System ◽  
P Value ◽  
Failure Assessment

Background: Present study was designed to note the indications for and the complications and outcome of women on mechanical ventilation in our obstetric intensive care unit, and in addition to look for the applicability and correlation of Sequential Organ Failure Assessment (SOFA) scores for the prediction of outcome in these women.Methods: A prospective observational study was conducted in the obstetric intensive care unit of our teaching hospital which included all women requiring mechanical ventilation in the study period. The diagnosis of the woman on admission, the clinical course and outcome along with total maximum sequential organ failure assessment (SOFA) score and SOFA score for each system were noted. Women were divided into two groups, survivors and non-survivors. Student t test and chi square test were used for analysis.Results: The foremost indication for mechanical ventilation was hypertension in pregnancy namely eclampsia and pre-eclampsia, followed by obstetric hemorrhage and then by hepatic failure. Maternal mortality rose significantly as the number of days of mechanical ventilation increased (p value <0.05). The total SOFA score correlated highly significantly with the outcome (p<0.0001).Conclusions: In women with eclampsia and pre-eclampsia suffering from respiratory failure, survival is inversely correlated with the number of days of mechanical ventilation. The total SOFA score is highly predictive of the woman’s outcome and all individual organ system scores also significantly correlate with outcome except for the score of coagulation system.

scholarly journals Prospective longitudinal observational study in assessing prognostic accuracy of sequential organ failure assessment and quick-sequential organ failure assessment scores in detecting morbidity and mortality in critically ill children

2021 ◽  
Vol 8 (10) ◽  
pp. 1684
Author(s):  
Naresh Kumar N. ◽  
Suresh Chelliah D. ◽  
Senguttuvan D.
Keyword(s):  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Critically Ill ◽  
Sofa Score ◽  
Morbidity And Mortality ◽  
Critically Ill Children ◽  
Assessment Score ◽  
Prognostic Accuracy ◽  
Failure Assessment ◽  
Sick Children

Background: The objective of the study was to assess prognostic accuracy of SOFA (sequential organ failure assessment score) and Q-SOFA (quick-sequential organ failure assessment) score in detecting morbidity and mortality in critically ill children admitted in our intensive care unit.Methods: All critically ill children admitted were recruited over a time period of 7 months. Q-SOFA score was assessed at presentation, followed by SOFA score on day 1 and day 2 of ICU stay and outcome was observed.Results: Total of 272 sick children were recruited and assessed. All eight (2.94%) mortalities had high Q-SOFA score of three (p<0.001), mean SOFA (day 1) score 11.12±0.99 (p<0.001), mean SOFA (day 2) was 11.62±1.40 (p<0.001).Conclusions: Q-SOFA is a simple, inexpensive and rapid test to assess and predict sick children requiring ICU care in emergency department. High SOFA score predicts high probability of mortality and detects organ failure early.

scholarly journals Sequential Organ Failure Assessment (SOFA) score in predicting morbidity and mortality in community and hospital acquired acute renal failure patient requiring dialysis

2018 ◽  
Vol 5 (3) ◽  
pp. 727
Author(s):  
Amit Pambhar ◽  
G. K. Mukhiya
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sofa Score ◽  
P Value ◽  
Renal Failure Patient ◽  
Failure Assessment ◽  
Hospital Acquired ◽  
Excellent Tool

Background: The Sequential Organ Failure Assessment (SOFA) score is an excellent tool for assessing the extent of organ dysfunction in critically ill patients. This study was planned to compare outcome and organ failure status of community (CAARF) and hospital acquired acute renal failure (HAARF) patients requiring dialysis using SOFA score.Methods: The present prospective observational study was conducted on fifty consecutive acute renal failure patients age more than 18 years of either sex requiring dialysis. Patients who developed ARF after 24 hours of admission were referred as HAARF and patients who had acute renal failure on admission were considered as CAARF. The Sequential Organ Failure Assessment (SOFA) score was used to track a patient's status during the stay in an intensive care unit in both HAARF and CAARF patients.Results: Out of 50 patients, 31(62%) patients had community acquired renal failure and 19 (38%) patients had hospital acquired renal failure. Mean SOFA in HAARF patients was high (8.84±3.13) compare to CAARF patients (6.16± 2.80). The p value calculated was 0.003 which was significant. High SOFA Score (>11) were seen predominantly in HAARF (83.3%) patients compare to CAARF (16.7%), followed by 57.1% of patients in HAARF and 42.9% of patients in CAARF had SOFA score between 9 to11.Conclusions: High SOFA Score were seen predominantly in HAARF patients compare to CAARF and so poor outcome compare to CAARF. So, SOFA score may be used in explaining prognosis and outcome of ARF patients.

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