The Sequential Organ Failure Assessment Score For Evaluating Outcome In Septic Patients At The Time Of Emergency Department Presentation

Objective:The objective of this study is to examine the utility of SOFA score in evaluating the outcome of septic patients at12to24hrs after admission in the Emergency Department.Methods:We enrolled84septic patients from January2013to June2013from Tianjin Medical University, General Hospital Emergency Department. Patients were selected according to2001International sepsis guidelines. We calculated total maximum SOFA at12to24hrs admission in the ED. The physical and clinical history (age, sex, heart rate, respiratory rate, blood pressure, temperature, Glasgow Coma scale, primary infection site, co-morbid condition, sample source, pathogen), blood parameters (arterial blood gas, haemoglobin, platelet, white blood cell, creatinine, bilirubin, Hs-TSH, free T3, free T4), echocardiography (EF, LVDD, IVS), in hospital mortality rate, FiO2need of vassopressor in days were included in the study. Two groups were made according the SOFA score. First group was patient with SOFA score<2and the second were participants with SOFA score≥2. We performed univariate, logistics and receiver operating characteristic curve to assess clinical characteristics, the severity of sepsis and to evaluate prognosis of septic patient.Results:(1) While comparing two SOFA groups, the value of HR, RR, GCS, creatinine, platelet, lactate, mortality, severity of sepsis, co-morbidity, PaO2, PaO2/FiO2and pathogen were statistically significant in univariate analysis. Further, the value of creatinine, platelet, lactate and individuals infected with gram negative organisms further came significant with logistics.(P<0.05)(2) None of the variables (advanced age, sex, primary infection site, sample source, MAP, SBP, DBP,T, Hb, bilirubin, hs-TSH, free T3, free T4, ph, WBC, EF, LVDD and IVS) were statistically significantly while comparing two SOFA groups.(P>0.05)(3) The SOFA≥2group had statistically significant higher values of creatinine and lactate and lower values of platelet than the other group. Each unit increase in creatinine and lactate level and decrease in platelet level can increase1.14,9.76, and34.48times of odd ratios that the patient will develop organ dysfunction. This study indicated that the individuals infected with gram negative organisms in SOFA≥2groups were104.47times more likely to develop organ dysfunction than the patient infected with gram positive, mixed gram negative and positive organisms, fungus and mixed fungus and bacterial infection. The survival rate of septic patients’can decrease by3.68times of odd ratio with each unit increase in SOFA score.(4) The area under the receiver operating characteristics curve of SOFA for predicting mortality at T12-24hrs was0.941(95%confidence interval.901-.981). The maximum total SOFA had the maximum area under the curve compared to the AUC of lactate, severity of sepsis, creatinine, platelet and GCS.Conclusion:①SOFA is a simple and effective method to describe organ dysfunction/failure in ED patients.②SOFA score can stratify the sepsis severity. The total maximum SOFA score demonstrated a good accuracy for predicting in hospital mortality when applied to septic patient at the12to24hrs of admission in ED. It can help the emergency physician to monitor clinical course of sepsis and also aid in predicting mortality and assessing organ dysfunction/failure.③The clinical and demographics of our patient profile shows that organ dysfunction occurs most commonly among vulnerable patients such as patient with high SOFA score, creatinine and lactate level, patient with low platelet level and individuals infected with gram negative organisms. These groups of septic patients should be promptly managed in the ED.