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Application of the Sequential Organ Failure Assessment Score to Cardiac Surgical Patients^*

^* From the Department of Anesthesia and ICU (Drs. Ceriani, Mazzoni, Bortone, and Solinas), Humanitas Gavazzeni, Bergamo; the Division of Epidemiology and Biostatistics (Dr. Gandini) and Department of Anesthesia and ICU (Dr. Susini), European Institute of Oncology, Milano; and Section of Milano (Dr. Parodi), CNR Clinical Physiology Institute, Niguarda Ca’ Granda Hospital, Milano, Italy.

Correspondence to: Maurizio Mazzoni, MD, Anestesia e Terapia Intensiva, Humanitas Gavazzeni, Via Mauro Gavazzeni 21, 24125 Bergamo, Italy; e-mail: maurizio.mazzoni{at}gavazzeni.it

Objective: To assess the applicability of the sequential organ failure assessment (SOFA) score to cardiac surgical patients.

Design: Observational cohort study.

Setting: Adult cardiac surgical ICU.

Patients: Two hundred eighteen patients requiring ICU stay > 96 h.

Measurements and results: The SOFA score was calculated daily until ICU discharge. Derived SOFA variables—total maximum SOFA (TMS), SOFA, maximum SOFA (maxSOFA), and maxSOFA—were considered. Length of ICU stay was 8.9 ± 6.7 days (mean ± SD). The mortality rate was 11.0% in the ICU and 15.6% in the hospital. Nonsurvivors had higher TMS, SOFA, single-organ system, and mean total scores on day 1 (9.8 ± 2.5 vs 7.8 ± 2.3, p < 0.05) and thereafter until day 10. The total SOFA score on the first 10 days of ICU stay, time, survival status, and their interaction were all significant (p < 0.001), with higher SOFA scores for nonsurvivors, and lower scores for survivors that decreased as the number of days from operation increased. Cardiovascular score on day 1 carried the highest relative risk of mortality among other systems (risk ratio [RR], 2.12; 95% confidence interval [CI], 1.31 to 3.45; p < 0.01), as did maximum cardiovascular score (RR, 2.81; 95% CI, 1.62 to 4.85; p < 0.001). A growing number of failing organs was associated with mortality, from the first to the sixth postoperative day (p < 0.05). Total score on day 1, TMS, SOFA, maxSOFA, and maxSOFA were reliable predictors of mortality with area under receiver operating characteristic curve of 0.71 (SE, 0.08), 0.89 (SE, 0.05), 0.86 (SE, 0.06), 0.88 (SE, 0.05), and 0.88 (SE, 0.06), respectively. Length of hospital stay was significantly associated (p = 0.05) to TMS and SOFA and not to other SOFA scores, age, or sex.

Conclusions: The SOFA score may be used to grade the severity of postoperative morbidity in cardiac surgical patients without specific adaptations. The model identifies patients at increased risk for postoperative mortality.

Key Words: cardiac surgical procedures • critical illness • intensive care • multiple organ failure • outcome assessment • postoperative complications • severity of illness index

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