UMEM Educational Pearls

Category: Critical Care

Title: Association Between Levels of Intensive Care and In-Hospital Mortality in Patients Hospitalized for Sepsis Stratified by Sequential Organ Failure Assessment Scores

Keywords: SOFA, admission unit, ICU, IMC, Ward, morality (PubMed Search)

Posted: 10/17/2023 by Quincy Tran, MD (Updated: 4/28/2024)
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Settings: Retrospective study of a national inpatient database (Japan).

Participants:

All patients who were admitted between April 1, 2018 and March 31, 2021 with a SOFA score > 2 on admission day.
Propensity score matching using SOFA score at admission was used to group patients according to the first unit of admission. The units of admissions were: ICU, High-dependency unit (HDU, which is also called Intermediate care unit), general ward.

Outcome measurement: Primary outcome was in-hospital mortality, after propensity score matching.

Study Results:

There were 19770 patients admitted to the IC, 23066 patients in the HDU and 54,234 patients in the ward.
There were no significant differences in in-hospital mortality among cohorts with SOFA scores of 3–5.
Patients with SOFA => 6 and admitted to the ICU or HDU were associated with lower mortality than patients with same SOFA score but admitted to the ward (Risk difference -2.3 (95% CI -4.6 to -0.1, P=0.041).
Patients who had SOFA > 12 and was admitted to the ICU group were associated with significantly lower in-hospital mortality than those with similar SOFA score but was admitted to the HDU (Risk difference -4.3, 95% CI -7.5 to -1.0, P = 0.010)

Discussion:

Most of the high SOFA scores among ICU patients were due to norepinephrine or mechanical ventilation.
Patients with SOFA 2-5 and were admitted to the ICU/HDU were associated with higher mortality than those admitted to the ward. This was mostly from patients who needed intensive monitoring, and not support for organ failure.
ICU admission is also associated with certain adverse events (2).

Conclusion:

Risk-stratifying patients according to SOFA score is a potential strategy for appropriate admission strategies.

References

1.Ohbe H, Sasabuchi Y, Doi K, Matsui H, Yasunaga H. Association Between Levels of Intensive Care and In-Hospital Mortality in Patients Hospitalized for Sepsis Stratified by Sequential Organ Failure Assessment Scores. Crit Care Med. 2023 Sep 1;51(9):1138-1147. doi: 10.1097/CCM.0000000000005886. Epub 2023 Apr 28. PMID: 37114933.

2.Corwin GS, Mills PD, Shanawani H, Hemphill RR. Root Cause Analysis of ICU Adverse Events in the Veterans Health Administration. Jt Comm J Qual Patient Saf. 2017 Nov;43(11):580-590. doi: 10.1016/j.jcjq.2017.04.009. Epub 2017 Jul 25. PMID: 29056178.