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

Publication ,  Journal Article
Rakhit, S; Wang, L; Lindsell, CJ; Hosay, MA; Stewart, JW; Owen, GD; Frutos-Vivar, F; Pen Uelas, O; Esteban, AS; Anzueto, AR; Raymondos, K ...
Published in: Ann Surg
August 1, 2022

OBJECTIVE: 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). SUMMARY BACKGROUND DATA: The SOFA score, whose neurologic component is based on the GCS, can predict intensive care unit (ICU) mortality. But, GCS is often missing in lieu of other assessments, such as the also reliable and validated Richmond Agitation Sedation Scale (RASS). Single-center data suggested an RASS-based SOFA (mSOFA) predicted ICU mortality. METHODS: Our nested cohort within the prospective 2016 Fourth International Study of Mechanical Ventilation contains 4120 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 postoperative status (medical/surgical). RESULTS: Cohort-wide, the mean SOFA=9.4+/-2.8 and mean mSOFA = 10.0+/-2.3, with ICU mortality = 31%. Mean SOFA and mSOFA similarly predicted ICU mortality (SOFA: AUC = 0.784, 95% CI = 0.769-0.799; mSOFA: AUC = 0.778, 95% CI = 0.763-0.793, P = 0.139). Across models, other predictors of mortality included higher age, female sex, medical patient, and African region (all P < 0.001). CONCLUSIONS: We present the first SOFA modification with RASS in a "real-world" international cohort. Estimating GCS from RASS preserves predictive validity of SOFA to predict ICU mortality. Alternative neurologic measurements like RASS can be viably integrated into severity of illness scoring systems like SOFA.

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Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

August 1, 2022

Volume

276

Issue

2

Start / End Page

e114 / e119

Location

United States

Related Subject Headings

  • Surgery
  • Prospective Studies
  • Organ Dysfunction Scores
  • Male
  • Intensive Care Units
  • Humans
  • Glasgow Coma Scale
  • Female
  • Cohort Studies
  • 3202 Clinical sciences
 

Citation

APA
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ICMJE
MLA
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Rakhit, S., Wang, L., Lindsell, C. J., Hosay, M. A., Stewart, J. W., Owen, G. D., … Patel, M. B. (2022). Multicenter International Cohort Validation of a Modified Sequential Organ Failure Assessment Score Using the Richmond Agitation-sedation Scale. Ann Surg, 276(2), e114–e119. https://doi.org/10.1097/SLA.0000000000004484
Rakhit, Shayan, Li Wang, Christopher J. Lindsell, Morgan A. Hosay, James W. Stewart, Gary D. Owen, Fernando Frutos-Vivar, et al. “Multicenter International Cohort Validation of a Modified Sequential Organ Failure Assessment Score Using the Richmond Agitation-sedation Scale.Ann Surg 276, no. 2 (August 1, 2022): e114–19. https://doi.org/10.1097/SLA.0000000000004484.
Rakhit S, Wang L, Lindsell CJ, Hosay MA, Stewart JW, Owen GD, et al. Multicenter International Cohort Validation of a Modified Sequential Organ Failure Assessment Score Using the Richmond Agitation-sedation Scale. Ann Surg. 2022 Aug 1;276(2):e114–9.
Rakhit, Shayan, et al. “Multicenter International Cohort Validation of a Modified Sequential Organ Failure Assessment Score Using the Richmond Agitation-sedation Scale.Ann Surg, vol. 276, no. 2, Aug. 2022, pp. e114–19. Pubmed, doi:10.1097/SLA.0000000000004484.
Rakhit S, Wang L, Lindsell CJ, Hosay MA, Stewart JW, Owen GD, Frutos-Vivar F, Pen Uelas O, Esteban AS, Anzueto AR, Raymondos K, Rios F, Thille AW, Gonza Lez M, Du B, Maggiore SM, Matamis D, Abroug F, Amin P, Zeggwagh AA, Ely EW, Vasilevskis EE, Patel MB. Multicenter International Cohort Validation of a Modified Sequential Organ Failure Assessment Score Using the Richmond Agitation-sedation Scale. Ann Surg. 2022 Aug 1;276(2):e114–e119.

Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

August 1, 2022

Volume

276

Issue

2

Start / End Page

e114 / e119

Location

United States

Related Subject Headings

  • Surgery
  • Prospective Studies
  • Organ Dysfunction Scores
  • Male
  • Intensive Care Units
  • Humans
  • Glasgow Coma Scale
  • Female
  • Cohort Studies
  • 3202 Clinical sciences