Abstract
Objectives
To compare the accuracy of the Sequential Organ Failure Assessment
(SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II)
Scores in predicting mortality among intensive care unit (ICU) patients
with sepsis in a low-income and middle-income country.
Design
A multicentre, cross-sectional study.
Setting
A total of 15 adult ICUs throughout Vietnam.
Participants
We included all patients aged ≥18 years who were admitted to ICUs
for sepsis and who were still in ICUs from 00:00 to 23:59 of the
specified study days (ie, 9 January, 3 April, 3 July and 9 October of
the year 2019).
Primary and secondary outcome measures
The primary outcome was hospital all-cause mortality (hospital
mortality). We also defined the secondary outcome as all-cause deaths in
the ICU (ICU mortality).
Results
Of 252 patients, 40.1% died in hospitals, and 33.3% died in ICUs.
SOFA Score (areas under the receiver operating characteristic curve
(AUROC): 0.688 (95% CI 0.618 to 0.758); cut-off value≥7.5;
PAUROC<0.001) and APACHE II Score (AUROC:
0.689 (95% CI 0.622 to 0.756); cut-off value ≥20.5;
PAUROC<0.001) both had a poor discriminatory
ability for predicting hospital mortality. However, the discriminatory
ability for predicting ICU mortality of SOFA (AUROC: 0.713 (95% CI 0.643
to 0.783); cut-off value≥9.5; PAUROC<0.001) was
fair and was better than that of APACHE II Score (AUROC: 0.672 (95% CI
0.603 to 0.742); cut-off value≥18.5;
PAUROC<0.001). A SOFA Score≥8 (adjusted OR
(AOR): 2.717; 95% CI 1.371 to 5.382) and an APACHE II Score≥21 (AOR:
2.668; 95% CI 1.338 to 5.321) were independently associated with an
increased risk of hospital mortality. Additionally, a SOFA Score≥10
(AOR: 2.194; 95% CI 1.017 to 4.735) was an independent predictor of ICU
mortality, in contrast to an APACHE II Score≥19, for which this role did
not.
Conclusions
In this study, SOFA and APACHE II Scores were worthwhile in
predicting mortality among ICU patients with sepsis. However, due to
better discrimination for predicting ICU mortality, the SOFA Score was
preferable to the APACHE II Score in predicting mortality.
Clinical trials registry – India:NCT016898.
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