Mortality predictors for ICU end-of-life decisions: delta-SOFA and SAPS 3 - retrospective evaluation.

IF 2 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES
Maria Carmen Sala-Trull, Pablo Monedero, Francisco Guillen-Grima, Pilar Leon-Sanz
{"title":"Mortality predictors for ICU end-of-life decisions: delta-SOFA and SAPS 3 - retrospective evaluation.","authors":"Maria Carmen Sala-Trull, Pablo Monedero, Francisco Guillen-Grima, Pilar Leon-Sanz","doi":"10.1136/spcare-2024-005357","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>End-of-life decisions in intensive care units (ICUs) are complex, influenced by patient severity, treatment efficacy and resource constraints. This study assessed the predictive value of delta-Sequential Organ Failure Assessment (SOFA) scores on days 2, 3 and 5, both independently and combined with Simplified Acute Physiology Score (SAPS) 3, for in-hospital mortality.</p><p><strong>Methods: </strong>A retrospective cohort study analysed ICU patients with stays of≥5 days from 2018 to 2020. Clinical data included SAPS 3 and SOFA scores at admission, 48 hours and on days 3 and 5, alongside mortality outcomes. Logistic regression and discriminant analysis identified mortality predictors and evaluated model performance.</p><p><strong>Results: </strong>Among 200 patients, 26% died in hospital. Non-survivors had significantly higher SAPS 3 scores (mean 51.9±11.9 vs 45.6±11.9 in survivors, p=0.001) and worsening SOFA scores, particularly on days 3 and 5. Combining SAPS 3 with delta-SOFA on day 5 produced an area under the receiver operating characteristic (AUROC) of 0.71 (95% CI: 0.63 to 0.79), indicating moderate predictive ability.</p><p><strong>Conclusions: </strong>Integrating the delta-SOFA score on day 5 with SAPS 3 improves in-hospital mortality predictions during prolonged ICU stays. Findings suggest early treatment limitations within 48 hours may be premature, as patient responses evolve and shared decision-making becomes more feasible over time.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"518-521"},"PeriodicalIF":2.0000,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Supportive & Palliative Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/spcare-2024-005357","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0

Abstract

Objectives: End-of-life decisions in intensive care units (ICUs) are complex, influenced by patient severity, treatment efficacy and resource constraints. This study assessed the predictive value of delta-Sequential Organ Failure Assessment (SOFA) scores on days 2, 3 and 5, both independently and combined with Simplified Acute Physiology Score (SAPS) 3, for in-hospital mortality.

Methods: A retrospective cohort study analysed ICU patients with stays of≥5 days from 2018 to 2020. Clinical data included SAPS 3 and SOFA scores at admission, 48 hours and on days 3 and 5, alongside mortality outcomes. Logistic regression and discriminant analysis identified mortality predictors and evaluated model performance.

Results: Among 200 patients, 26% died in hospital. Non-survivors had significantly higher SAPS 3 scores (mean 51.9±11.9 vs 45.6±11.9 in survivors, p=0.001) and worsening SOFA scores, particularly on days 3 and 5. Combining SAPS 3 with delta-SOFA on day 5 produced an area under the receiver operating characteristic (AUROC) of 0.71 (95% CI: 0.63 to 0.79), indicating moderate predictive ability.

Conclusions: Integrating the delta-SOFA score on day 5 with SAPS 3 improves in-hospital mortality predictions during prolonged ICU stays. Findings suggest early treatment limitations within 48 hours may be premature, as patient responses evolve and shared decision-making becomes more feasible over time.

ICU临终决定的死亡率预测因素:delta-SOFA和SAPS 3 -回顾性评价。
目的:重症监护病房(icu)的临终决定是复杂的,受患者严重程度、治疗效果和资源限制的影响。本研究评估了第2、3和5天的delta-Sequential Organ Failure Assessment (SOFA)评分对住院死亡率的预测价值,无论是独立还是联合简化急性生理评分(SAPS) 3。方法:回顾性队列研究分析2018 - 2020年ICU住院≥5天的患者。临床数据包括入院时、48小时、第3天和第5天的SAPS 3和SOFA评分,以及死亡率结果。逻辑回归和判别分析确定了死亡率预测因子并评估了模型的性能。结果:200例患者中26%在医院死亡。非幸存者的SAPS 3评分明显更高(幸存者平均51.9±11.9比45.6±11.9,p=0.001), SOFA评分恶化,特别是在第3天和第5天。结合SAPS 3和delta-SOFA,第5天的受试者工作特征下面积(AUROC)为0.71 (95% CI: 0.63 ~ 0.79),表明预测能力中等。结论:将第5天的delta-SOFA评分与SAPS 3相结合可改善延长ICU住院期间的住院死亡率预测。研究结果表明,随着时间的推移,患者的反应不断变化,共同决策变得更加可行,48小时内的早期治疗限制可能为时过早。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
BMJ Supportive & Palliative Care
BMJ Supportive & Palliative Care Medicine-Medicine (miscellaneous)
CiteScore
4.60
自引率
7.40%
发文量
170
期刊介绍: Published quarterly in print and continuously online, BMJ Supportive & Palliative Care aims to connect many disciplines and specialties throughout the world by providing high quality, clinically relevant research, reviews, comment, information and news of international importance. We hold an inclusive view of supportive and palliative care research and we are able to call on expertise to critique the whole range of methodologies within the subject, including those working in transitional research, clinical trials, epidemiology, behavioural sciences, ethics and health service research. Articles with relevance to clinical practice and clinical service development will be considered for publication. In an international context, many different categories of clinician and healthcare workers do clinical work associated with palliative medicine, specialist or generalist palliative care, supportive care, psychosocial-oncology and end of life care. We wish to engage many specialties, not only those traditionally associated with supportive and palliative care. We hope to extend the readership to doctors, nurses, other healthcare workers and researchers in medical and surgical specialties, including but not limited to cardiology, gastroenterology, geriatrics, neurology, oncology, paediatrics, primary care, psychiatry, psychology, renal medicine, respiratory medicine.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信