SOFA score is superior to APACHE-II score in predicting the prognosis of critically ill patients with acute kidney injury undergoing continuous renal replacement therapy

Ren Fail. 2020 Nov;42(1):638-645. doi: 10.1080/0886022X.2020.1788581.

Abstract

Background: Acute kidney injury (AKI) is the most common cause of organ failure in multiple organ dysfunction syndrome (MODS) and is associated with increased mortality. This study aimed at determining the efficacy of sequential organ failure assessment (SOFA), and acute physiology and chronic health evaluation II (APACHE-II) scoring systems in assessing the prognosis of critically ill patients with AKI undergoing CRRT.

Methods: The predictive value of SOFA and APACHE-II scores for 28- and 90-d mortality in patients with AKI undergoing continuous renal replacement therapy (CRRT) were determined by multivariate analysis, sensitivity analysis, and curve-fitting analysis.

Results: A total of 836 cases were included in this study. Multivariate Cox logistic regression analysis showed that SOFA scores were associated with 28- and 90-d mortality in patients with AKI undergoing CRRT. The adjusted HR of SOFA for28-d mortality were 1.18 (1.14, 1.21), 1.24 (1.18, 1.31), and 1.19 (1.13, 1.24) in the three models, respectively, and the adjusted HR of SOFA for 90-d mortality was 1.12 (1.09, 1.16), 1.15 (1.10, 1.19), and 1.15 (1.10, 1.19), respectively. The subgroup analysis showed that the SOFA score was associated with 28-d and 90-d mortality in patients with AKI undergoing CRRT. APACHE-II score was not associated with 28- and 90-d mortality patients with AKI undergoing CRRT. Curve fitting analysis showed that SOFA scores increased had a higher prediction accuracy for 28- and 90-d than APACHE-II.

Conclusions: The SOFA score showed a higher accuracy of mortality prediction in critically ill patients with AKI undergoing CRRT than the APACHE-II score.

Keywords: APACHE-II score; SOFA score; acute kidney injury; continuous renal replacement therapy.

MeSH terms

  • APACHE*
  • Acute Kidney Injury / etiology*
  • Acute Kidney Injury / mortality*
  • Acute Kidney Injury / therapy*
  • Adult
  • Aged
  • China / epidemiology
  • Continuous Renal Replacement Therapy / adverse effects*
  • Critical Illness / mortality
  • Female
  • Humans
  • Intensive Care Units / statistics & numerical data
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Organ Dysfunction Scores*
  • Predictive Value of Tests
  • Prognosis
  • Retrospective Studies
  • Risk Assessment / methods
  • Risk Factors
  • Time Factors

Grant support

Key R & D projects in Shaanxi Province (2019 sf-116).