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Chatterjee S, Jentzer JC, Kashyap R, Keegan MT, Dunlay SM, Passe MA, Loftsgard T, Murphree DH, Stulak JM. Sequential organ failure assessment score improves survival prediction for left ventricular assist device recipients in intensive care. Artif Organs 2022; 46:1856-1865. [PMID: 35403261 DOI: 10.1111/aor.14254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/04/2022] [Accepted: 02/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Preoperative risk scores facilitate patient selection, but postoperative risk scores may offer valuable information for predicting outcomes. We hypothesized that the postoperative Sequential Organ Failure Assessment (SOFA) score would predict mortality after left ventricular assist device (LVAD) implantation. METHODS We retrospectively reviewed data from 294 continuous-flow LVAD implantations performed at Mayo Clinic Rochester during 2007 to 2015. We calculated the EuroSCORE, HeartMate-II Risk Score, and RV Failure Risk Score from preoperative data and the APACHE III and Post Cardiac Surgery (POCAS) risk scores from postoperative data. Daily, maximum, and mean SOFA scores were calculated for the first 5 postoperative days. The area under receiver-operator characteristic curves (AUC) was calculated to compare the scoring systems' ability to predict 30-day, 90-day, and 1-year mortality. RESULTS For the entire cohort, mortality was 5% at 30 days, 10% at 90 days, and 19% at 1 year. The Day 1 SOFA score had better discrimination for 30-day mortality (AUC 0.77) than the preoperative risk scores or the APACHE III and POCAS postoperative scores. The maximum SOFA score had the best discrimination for 30-day mortality (AUC 0.86), and the mean SOFA score had the best discrimination for 90-day mortality (AUC 0.82) and 1-year mortality (AUC 0.76). CONCLUSIONS We observed that postoperative mean and maximum SOFA scores in LVAD recipients predict short-term and intermediate-term mortality better than preoperative risk scores do. However, because preoperative and postoperative risk scores each contribute unique information, they are best used in concert to predict outcomes after LVAD implantation.
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Affiliation(s)
- Subhasis Chatterjee
- Divisions of Acute Care Surgery & Trauma and Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College Medicine, Houston, Texas, USA.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA
| | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Rahul Kashyap
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Mark T Keegan
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Shannon M Dunlay
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Melissa A Passe
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Theodore Loftsgard
- Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Dennis H Murphree
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - John M Stulak
- Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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