Mortality prediction by SOFA score in ICU-patients after cardiac surgery; comparison with traditional prognostic-models

BMC Anesthesiol. 2020 Mar 13;20(1):65. doi: 10.1186/s12871-020-00975-2.


Background: There are many prognostic models and scoring systems in use to predict mortality in ICU patients. The only general ICU scoring system developed and validated for patients after cardiac surgery is the APACHE-IV model. This is, however, a labor-intensive scoring system requiring a lot of data and could therefore be prone to error. The SOFA score on the other hand is a simpler system, has been widely used in ICUs and could be a good alternative. The goal of the study was to compare the SOFA score with the APACHE-IV and other ICU prediction models.

Methods: We investigated, in a large cohort of cardiac surgery patients admitted to Dutch ICUs, how well the SOFA score from the first 24 h after admission, predict hospital and ICU mortality in comparison with other recalibrated general ICU scoring systems. Measures of discrimination, accuracy, and calibration (area under the receiver operating characteristic curve (AUC), Brier score, R2, and Ĉ-statistic) were calculated using bootstrapping. The cohort consisted of 36,632 Patients from the Dutch National Intensive Care Evaluation (NICE) registry having had a cardiac surgery procedure for which ICU admission was necessary between January 1st, 2006 and June 31st, 2018.

Results: Discrimination of the SOFA-, APACHE-IV-, APACHE-II-, SAPS-II-, MPM24-II - models to predict hospital mortality was good with an AUC of respectively: 0.809, 0.851, 0.830, 0.850, 0.801. Discrimination of the SOFA-, APACHE-IV-, APACHE-II-, SAPS-II-, MPM24-II - models to predict ICU mortality was slightly better with AUCs of respectively: 0.809, 0.906, 0.892, 0.919, 0.862. Calibration of the models was generally poor.

Conclusion: Although the SOFA score had a good discriminatory power for hospital- and ICU mortality the discriminatory power of the APACHE-IV and SAPS-II was better. The SOFA score should not be preferred as mortality prediction model above traditional prognostic ICU-models.

Keywords: Cardiac surgery; ICU mortality; ICU-scoring systems; Mortality discrimination; SOFA score.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Cardiac Surgical Procedures*
  • Cohort Studies
  • Critical Care / methods*
  • Female
  • Health Status Indicators*
  • Hospital Mortality*
  • Humans
  • Male
  • Netherlands / epidemiology
  • Postoperative Complications / mortality*
  • Prognosis
  • Reproducibility of Results
  • Severity of Illness Index