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Rakhit S, Wang L, Lindsell CJ, Hosay MA, Stewart JW, Owen GD, Frutos-Vivar F, Pen Uelas O, Esteban AS, Anzueto AR, Raymondos K, Rios F, Thille AW, Gonza Lez M, Du B, Maggiore SM, Matamis D, Abroug F, Amin P, Zeggwagh AA, Ely EW, Vasilevskis EE, Patel MB. Multicenter International Cohort Validation of a Modified Sequential Organ Failure Assessment Score Using the Richmond Agitation-sedation Scale. Ann Surg 2022; 276:e114-e119. [PMID: 33201122 PMCID: PMC10573707 DOI: 10.1097/sla.0000000000004484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE In a multicenter, international cohort, we aimed to validate a modified Sequential Organ Failure Assessment (mSOFA) using the Richmond Agitation-Sedation Scale, hypothesized as comparable to the Glasgow Coma Scale (GCS)-based Sequential Organ Failure Assessment (SOFA). SUMMARY BACKGROUND DATA The SOFA score, whose neurologic component is based on the GCS, can predict intensive care unit (ICU) mortality. But, GCS is often missing in lieu of other assessments, such as the also reliable and validated Richmond Agitation Sedation Scale (RASS). Single-center data suggested an RASS-based SOFA (mSOFA) predicted ICU mortality. METHODS Our nested cohort within the prospective 2016 Fourth International Study of Mechanical Ventilation contains 4120 ventilated patients with daily RASS and GCS assessments (20,023 patient-days, 32 countries). We estimated GCS from RASS via a proportional odds model without adjustment. ICU mortality logistic regression models and c-statistics were constructed using SOFA (measured GCS) and mSOFA (measured RASS-estimated GCS), adjusted for age, sex, body-mass index, region (Europe, USA-Canada, Latin America, Africa, Asia, Australia-New Zealand), and postoperative status (medical/surgical). RESULTS Cohort-wide, the mean SOFA=9.4+/-2.8 and mean mSOFA = 10.0+/-2.3, with ICU mortality = 31%. Mean SOFA and mSOFA similarly predicted ICU mortality (SOFA: AUC = 0.784, 95% CI = 0.769-0.799; mSOFA: AUC = 0.778, 95% CI = 0.763-0.793, P = 0.139). Across models, other predictors of mortality included higher age, female sex, medical patient, and African region (all P < 0.001). CONCLUSIONS We present the first SOFA modification with RASS in a "real-world" international cohort. Estimating GCS from RASS preserves predictive validity of SOFA to predict ICU mortality. Alternative neurologic measurements like RASS can be viably integrated into severity of illness scoring systems like SOFA.
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Affiliation(s)
- Shayan Rakhit
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Vanderbilt University School of Medicine, Nashville, TN
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Li Wang
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Morgan A Hosay
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN
- Baylor University, Waco, TX
| | - James W Stewart
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN
- Meharry Medical College, Nashville, TN
| | - Gary D Owen
- Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN
| | - Fernando Frutos-Vivar
- University Hospital of Getafe, Getafe, Community of Madrid, Spain
- Centro de Investigación Biomédica en red de Enfermedades Respiratorias, Getafe, Comunidad of Madrid, Madrid, Spain
| | - Oscar Pen Uelas
- University Hospital of Getafe, Getafe, Community of Madrid, Spain
- Centro de Investigación Biomédica en red de Enfermedades Respiratorias, Getafe, Comunidad of Madrid, Madrid, Spain
| | - Andre S Esteban
- University Hospital of Getafe, Getafe, Community of Madrid, Spain
- Centro de Investigación Biomédica en red de Enfermedades Respiratorias, Getafe, Comunidad of Madrid, Madrid, Spain
| | - Antonio R Anzueto
- Department of Pulmonary Diseases and Critical Care Medicine, University of Texas Health Science Center, San Antonio, TX
- Pulmonary Section, Audie L Murphy VA Hospital, South Texas Veterans Healthcare System, US Department of Veterans Affairs, San Antonio, TX
| | | | - Fernando Rios
- Alejandro Posadas National Hospital, El Palomar, Buenos Aires, Argentina
| | | | - Marco Gonza Lez
- Medellin Clinic and Pontifical Bolivaran University, Medellin, Colombia
| | - Bin Du
- Peking Union Medical College Hospital, Beijing, China
| | | | | | - Fekri Abroug
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Pravin Amin
- Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | | | - E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Vanderbilt University School of Medicine, Nashville, TN
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research, Education, and Clinical Center (GRECC) Service, Nashville VA Medical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs, Nashville, TN
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
| | - Eduard E Vasilevskis
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Vanderbilt University School of Medicine, Nashville, TN
- Geriatric Research, Education, and Clinical Center (GRECC) Service, Nashville VA Medical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs, Nashville, TN
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Ibn Sina University Hospital Center & Mohammed V University of Rabat, Rabat, Morocco
| | - Mayur B Patel
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Vanderbilt University School of Medicine, Nashville, TN
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
- Surgical Service, Nashville VA Medical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs Nashville, TN
- Departments of Neurosurgery and Hearing and Speech Sciences, Vanderbilt Brain Institute, Vanderbilt University Medical Center, Nashville, TN
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