Critical Care and Shock

Comparison of Apache II, SOFA, and Modified SOFA Scores in Predicting Mortality of Surgical Patients in Intensive Care Unit at Dr. Hasan Sadikin General Hospital


Introduction: Scoring systems were developed to assess the severity of organ failures and to predict mortality. The sequential organ failure assessment (SOFA) score and its modification (MSOFA) are gaining popularity through their proven simplicity, validity, and reliability in previous studies.

Objective: To determine and compare the validity of the SOFA and MSOFA scores with the Acute Physiology and Chronic Health Evaluation II (APACHE II) score for predicting mortality in surgical patients treated in ICU in Dr. Hasan Sadikin General Hospital in Bandung, West Java, Indonesia.

Patients and Methods: This was a prospective observational cohort study involving consecutively 144 surgical patients (from January 2008 to December 2008). APACHE II, SOFA, and MSOFA scores were determined on admission. SOFA and MSOFA scores were also repeated every 48-72 hours until ICU discharge or death for determining mean and maximum values of SOFA and MSOFA. Scores validation were determined using Hosmer-Lemeshow goodness-of-fit test and receiver operating characteristic (ROC) curve analyses to determine the area under the curve (AUC).

Results: Mortality rate was 39.8%. The mean APACHE II score (11.63±5.55, 14.95±4.27; p≤0.001), SOFA(3.7±2.23, 5.86±2.88, p≤0.001), and MSOFA(3.98±1.95, 5.79±1.98, p≤0.001) were all higher in non-survivors than in survivors. Discrimination was less satisfactory for APACHE II (AuROC=0.69; p≤0.001) and acceptable for both initial SOFA (AuROC=0.73; p≤0.001) and initial MSOFA (AuROC=0.75; p≤0.001). Mean and maximum values of SOFA and MSOFA showed even better discrimination values with AuROC=0.92; p≤0.001, and AuROC=0.91; p≤0.001 for meanSOFA and maksSOFA respectively, and AuROC=0.90; p≤0.001, AuROC=0.90; p≤0.001 for meanMSOFA and maksMSOFA respectively.

Conclusion: SOFA and MSOFA scoring systems are better than APACHE II system in predicting mortality in ICU surgical patients. Serial measurements of SOFA and MSOFA score significantly improve their predictive accuracy.