Multicenter International Cohort Validation of a Modified Sequential Organ Failure Assessment Score Using the Richmond Agitation-Sedation Scale

Annals of Surgery
Shayan RakhitMayur B Patel

Abstract

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). The SOFA score, whose neurologic component is based on the GCS, can predict ICU mortality. But, GCS is often missing in lieu of other assessments, such as the also reliable and validated RASS. Single center data suggested a RASS-based SOFA (mSOFA) predicted ICU mortality. Our nested cohort within the prospective 2016 Fourth International Study of Mechanical Ventilation contains 4,120 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 post-operative status (medical/surgical). Cohort-wide, the mean SOFA=9.4+/-2.8 and mean mSOFA = 10.0+/-2.3, with ICU mortality = 31%. Mean SOFA and mSOFA...Continue Reading

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