Dynamic SOFA score assessments to predict outcomes after acute admission of octogenarians to the intensive care unit.

<h4>Background</h4>Identifying which octogenarians could benefit most from continuing critical care is challenging. We aimed to see if responses to therapies using the sequential organ failure assessment (SOFA) score on day 4 after unplanned admission to the intensive care unit (ICU) cou...

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Autores principales:	Emmanuelle Loyrion, Lydiane Agier, Thibaut Trouve-Buisson, Gaetan Gavazzi, Carole Schwebel, Jean-Luc Bosson, Jean-François Payen
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/6b4fde2b37134582bccd547d549ef234
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spelling	oai:doaj.org-article:6b4fde2b37134582bccd547d549ef2342021-12-02T20:18:53ZDynamic SOFA score assessments to predict outcomes after acute admission of octogenarians to the intensive care unit.1932-620310.1371/journal.pone.0253077https://doaj.org/article/6b4fde2b37134582bccd547d549ef2342021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0253077https://doaj.org/toc/1932-6203<h4>Background</h4>Identifying which octogenarians could benefit most from continuing critical care is challenging. We aimed to see if responses to therapies using the sequential organ failure assessment (SOFA) score on day 4 after unplanned admission to the intensive care unit (ICU) could be associated with short-term mortality.<h4>Methods</h4>In this prospective observational cohort study, data from 4 ICUs in a University Hospital included SOFA scores on admission and day 4, along with preadmission measurements of frailty, comorbidities, nutritional status and number of medications. Outcome measures included mortality and loss of autonomy on day 90 after admission.<h4>Results</h4>Eighty-seven critically ill patients aged 80 years or older with preadmission functional independence and no missing SOFA score data on day 4 were studied (primary analyses). The mortality rate on day 90 was 30%. In a univariate Cox model, the SOFA score on day 4 was significantly associated with mortality rate: hazard ratio = 1.18 per one-point increase, 95% confidence interval (CI), 1.08 to 1.28 (p<0.001). A SOFA score of 6 or more on day 4 could correctly classify 75% of patients who died on day 90, with a sensitivity of 54% and a specificity of 84%. After adjustment, the SOFA score on day 4, neurological failure on admission and the number of preadmission medications were significantly associated with mortality on day 90, with an area under the receiver operating characteristic curve of 0.81 (95% CI, 0.71 to 0.91). These findings were confirmed in a sensitivity analysis with 109 patients. Preadmission frailty was the only variable independently associated with loss of autonomy in the 49 surviving patients.<h4>Conclusion</h4>Measuring SOFA score on day 4 and preadmission frailty could help predict mortality and loss of autonomy on day 90 in octogenarians after their acute admission to the ICU.Emmanuelle LoyrionLydiane AgierThibaut Trouve-BuissonGaetan GavazziCarole SchwebelJean-Luc BossonJean-François PayenPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 8, p e0253077 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Emmanuelle Loyrion Lydiane Agier Thibaut Trouve-Buisson Gaetan Gavazzi Carole Schwebel Jean-Luc Bosson Jean-François Payen Dynamic SOFA score assessments to predict outcomes after acute admission of octogenarians to the intensive care unit.
description	<h4>Background</h4>Identifying which octogenarians could benefit most from continuing critical care is challenging. We aimed to see if responses to therapies using the sequential organ failure assessment (SOFA) score on day 4 after unplanned admission to the intensive care unit (ICU) could be associated with short-term mortality.<h4>Methods</h4>In this prospective observational cohort study, data from 4 ICUs in a University Hospital included SOFA scores on admission and day 4, along with preadmission measurements of frailty, comorbidities, nutritional status and number of medications. Outcome measures included mortality and loss of autonomy on day 90 after admission.<h4>Results</h4>Eighty-seven critically ill patients aged 80 years or older with preadmission functional independence and no missing SOFA score data on day 4 were studied (primary analyses). The mortality rate on day 90 was 30%. In a univariate Cox model, the SOFA score on day 4 was significantly associated with mortality rate: hazard ratio = 1.18 per one-point increase, 95% confidence interval (CI), 1.08 to 1.28 (p<0.001). A SOFA score of 6 or more on day 4 could correctly classify 75% of patients who died on day 90, with a sensitivity of 54% and a specificity of 84%. After adjustment, the SOFA score on day 4, neurological failure on admission and the number of preadmission medications were significantly associated with mortality on day 90, with an area under the receiver operating characteristic curve of 0.81 (95% CI, 0.71 to 0.91). These findings were confirmed in a sensitivity analysis with 109 patients. Preadmission frailty was the only variable independently associated with loss of autonomy in the 49 surviving patients.<h4>Conclusion</h4>Measuring SOFA score on day 4 and preadmission frailty could help predict mortality and loss of autonomy on day 90 in octogenarians after their acute admission to the ICU.
format	article
author	Emmanuelle Loyrion Lydiane Agier Thibaut Trouve-Buisson Gaetan Gavazzi Carole Schwebel Jean-Luc Bosson Jean-François Payen
author_facet	Emmanuelle Loyrion Lydiane Agier Thibaut Trouve-Buisson Gaetan Gavazzi Carole Schwebel Jean-Luc Bosson Jean-François Payen
author_sort	Emmanuelle Loyrion
title	Dynamic SOFA score assessments to predict outcomes after acute admission of octogenarians to the intensive care unit.
title_short	Dynamic SOFA score assessments to predict outcomes after acute admission of octogenarians to the intensive care unit.
title_full	Dynamic SOFA score assessments to predict outcomes after acute admission of octogenarians to the intensive care unit.
title_fullStr	Dynamic SOFA score assessments to predict outcomes after acute admission of octogenarians to the intensive care unit.
title_full_unstemmed	Dynamic SOFA score assessments to predict outcomes after acute admission of octogenarians to the intensive care unit.
title_sort	dynamic sofa score assessments to predict outcomes after acute admission of octogenarians to the intensive care unit.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/6b4fde2b37134582bccd547d549ef234
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Dynamic SOFA score assessments to predict outcomes after acute admission of octogenarians to the intensive care unit.

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