Comparison of Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II and IV (APACHE) Scoring System Validity as Mortality Predictors in ICU Patients with Multiple Organ Dysfunction Syndrome in Sepsis

BACKGROUND Multiple organ dysfunction syndrome (MODS) has recently been considered as a defining syndrome of sepsis and is responsible for a high mortality rate among the patients in the intensive care units (ICUs). Prognostication of the ICU patients is an integral part of the management of the critically ill patients and many scoring systems, for that matter, have been devised and compared for their efficiency at predicting mortality. This study was conducted to evaluate and compare the validity of sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation (APACHE II) and APACHE IV as mortality predictors in intensive care unit (ICU) patients suffering from MODS in sepsis. METHODS Hundred patients diagnosed with MODS in sepsis were carefully examined, followed by relevant laboratory investigations. The SOFA score was calculated daily, and the APACHE II and IV scores were calculated on the day of admission. The scores were further compared among the survivors and the non-survivors, followed by receiver operating characteristic (ROC) curve analysis of the SOFA D1, D2, and D3 and the APACHE II and IV scores to estimate their capability of mortality prediction. RESULTS The means of the APACHE II, IV and SOFA D1 were 16.57 ± 6.49, 71.91 ± 16.19 and 8.75 ± 2.20, respectively. There was a statistically significant difference in the mean APACHE II scores (14.23 ± 5.20 vs. 21.12 ± 6.38) and the mean APACHE IV scores (67.27 ± 13.21 vs. 80.91 ± 17.77) in the survivors and the nonsurvivors. A statistically significant difference was also evident in the mean ages of the survivors and the non-survivors (52.82 ± 14.67 years vs. 63.25 ± 16.98 years). The SOFA score was high among the non-survivors than the survivors right from day-1 (10.24 ± 2.08 vs. 7.98 ± 1.86) to day-20 (15.00 ± 0.00 vs. 3.14 ± 0.38). Furthermore, ROC analysis showed that the best discrimination was provided by SOFA D3 followed by the APACHE II and SOFA D1 scores, with APACHE IV score showing the least. CONCLUSIONS SOFA score on day 3 provides the best mortality prediction in patients with MODS in sepsis, as compared to APACHE II and IV scores. KEYWORDS SOFA, APACHE II, APACHE IV, Multiple Organ Dysfunction Syndrome, Sepsis