Organ dysfunction scoring systems

In an attempt to improve on currently available systems, a new scale has recently been developed by the European Society of Intensive Care Medicine. The

Sepsis-related Organ Failure Assessment (SOFA) score (Table 1) was created to allow easy repeated assessment of the degree of individual organ dysfunction in all critically ill patients. It aims to assess morbidity, and therefore complements other scales which focus on mortality. The score is limited to the assessment of six organs, each being awarded a score between zero (normal) and 4, based on the worst values on each day. The variables necessary for each organ were chosen for their simplicity and are routinely measured in most ICUs. Therefore indices are available on a daily basis, allowing regular reassessment of patient condition. As the mortality is directly related to the degree of organ failure, it is also related to the SOFA score. In retrospective studies, the mortality has been shown to increase with increasing SOFA scores for each organ.

Table 1 The SOFA score

Several other scoring systems have been proposed recently. A major difference between them is in their definition of cardiovascular dysfunction. The Multiple Organ Dysfunction Score (MODS) uses a complex calculation of the pressure-adjusted heart rate averaged over a 24-h period, thus removing the simplicity of the system. The Brussels score uses hypotension and acidemia, but acidemia may be due to factors other than circulatory failure, including renal failure. The SOFA score uses the requirement for adrenergic support, which varies from one hospital to the next, but broad categories are used to avoid major conflicts.

The ability to quantify the severity of dysfunction of each individual organ enables therapy to be appropriately directed, and repeated scores allow the effects of treatment to be assessed

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