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There are many assessment tools available in the medical field such as SOFA Scores and APACHE Scores. These scores help medical staff identify the patients that are at risk of developing serious conditions and can implement treatment options to increase positive outcomes. Today we will focus on SOFA scores.
Our study was conducted using a dataset of 153.58 MB (1.05 million rows) and 43 columns from patients with sepsis. Early sepsis detection has the potential to save lives.To detect the sepsis early the healthcare provider used the technique with a SOFA score.According to the physionet.org “It is a two-point change in the patient's Sequential Organ Failure Assessment (SOFA) score and clinical suspicion of infection (as defined by the ordering of blood cultures or IV antibiotics) indication for sepsis.If the SOFA score is high, it indicates some of the organs are dysfunctioning. So they need to start monitoring the patient and give appropriate treatment and timely medication to prevent further complications. Early detection and antibiotic treatment of sepsis are critical for improving sepsis outcomes, where each hour of delayed treatment has been associated with roughly an 4-8% increase in mortality.”
What is sepsis?
Sepsis is a life-threatening condition that occurs when the body's response to infection causes tissue damage, organ failure, or death.According to physionet.org defines ”Internationally, an estimated 30 million people develop sepsis and 6 million people die from sepsis each year; an estimated 4.2 million newborns and children are affected (WHO). Sepsis costs U.S. hospitals more than any other health condition at $24 billion (13% of U.S. healthcare expenses) a year, and a majority of these costs are for sepsis patients that were not diagnosed at admission.”
What is the SOFA Score?
According to wikipedia: “The sequential organ failure assessment score (SOFA score), previously known as the sepsis-related organ failure assessment score,is used to track a person's status during the stay in an intensive care unit (ICU) to determine the extent of a person's organ function or rate of failure.The score is based on six different scores, one each for the respiratory ,cardiovascular, hepatic ,coagulation , renal and neurological system”.
The SOFA score value ranges from 0 to 24, with higher scores indicating organ dysfunction and a risk of mortality.
How to calculate the SOFA Score ?
In our Dataset we scored only on respiratory ,cardiovascular, renal ,coagulation ,liver because we didn’t get further information in our data set.
Score | Mean arterial pressure OR administration of vasopressors required | PaO2/FiO2 [mmHg (kPa)] | Platelets (×103/μl) | Bilirubin (mg/dl) | Creatinine (mg/dl) |
+0 | [MAP]>=70 mmHg | ≥ 400 (53.3) | ≥ 150 | < 1.2 | < 1.2 |
+1 | [MAP]<=70 and [MAP] > 60 mmHg | < 400 (53.3) | < 150 | 1.2–1.9 | 1.2–1.9 |
+2 | [MAP]<=60 and [MAP] > 50 mmHg | < 300 (40) | < 100 | 2.0–5.9 | 2.0–3.4 |
+3 | [MAP]<= 50 and [MAP] > 50 | < 200 | < 50 | 6.0–11.9 | 3.5–4.9 |
+4 | [MAP]<= 40 and [MAP] >=0 | < 100 | < 20 | > 12.0 | > 5.0 |
Based on the above table we calculated the score for each patient and given a score for each organ ,then at last we added up all the scores to find the SOFA score. This value helps the healthcare provider to estimate the organ functionality.
Our Analysis:
By knowing the importance of SOFA score and how critical that is for healthcare providers. We did the analysis on Q-SOFA too .Q_SOFA is a Quick SOFA score simplified version of the SOFA Score as an initial way to identify patients at high risk for poor outcome with an infection.
qSOFA simplifies the SOFA score drastically by only including its 3 clinical criteria. qSOFA can easily and quickly be repeated serially on patients.
Biomarker | qSOFA score |
(SBP ≤ 100 mmHg) | 1 |
RESP (≥ 22 breaths/min) | 1 |
Altered mentation (GCS ≤ 14) | 1 |
The score ranges from 0 to 3 points ,the score of 2 or more indicates the onset of infection was associated with a greater risk of death or prolonged intensive care unit stay. These are outcomes that are more common in infected patients who may be septic than those with uncomplicated infection.
In our Dataset we did scoring only on SBP and respiratory because we didn’t get further information in our data set.
Our Findings:
1) Q-SOFA
Trigger hour: At this hour two or more SIRS condition is met.SIRS condition
SIRS condition :
1. Fever >38◦C or < 36◦C
2. Heart rate >90 beats per minute
3. Respiratory rate >20 breaths per minute or PaCO2 <32 mm Hg
4. Abnormal white blood cell count (>12,000/mm3 or <4,000/ mm3 or >10% bands)
Onset hour: At this hour the patient has been diagnosed with sepsis.
Insight:
It shows that at trigger hour, 56% of patients are in moderate (1-score) and high (2-score) risk category whereas at onset hour 45% of patients are in high (2-score) risk category.
This means that the patients who were in the moderate to high-risk category at trigger hour need close monitoring to avoid the development of sepsis.
2) SOFA
Trigger hour: At this hour two or more SIRS condition is met.SIRS condition
SIRS condition :
1. Fever >38◦C or < 36◦C
2. Heart rate >90 beats per minute
3. Respiratory rate >20 breaths per minute or PaCO2 <32 mm Hg
4. Abnormal white blood cell count (>12,000/mm3 or <4,000/ mm3 or >10% bands)
Onset hour: At this hour the patient has been diagnosed with sepsis.
Here we further categorized the SOFA Score as low,moderate and high.
Low : 0 to 5.
Moderate: 6 to 9
High: >=10
Insight:
Most of the patients have Fair amount of Patients in low/moderate category at trigger hour have fallen into moderate/High category at onset hour. The above visual shows how patients move from one catergory to the other over time along with their severity at the trigger hour as well as onset hour.
Conclusion:
Scores like APACHE and SOFA are widely used assessment tools in the medical field that help the medical staff determine the patient's severity and can help them make timely decisions, change the treatment strategies to increase the positive outcomes.