Usefulness of Measuring Changes in SOFA Score for the Prediction of 28-Day Mortality in Patients With Sepsis-Associated Disseminated Intravascular Coagulation

Abstract

The primary end point for sepsis trial is 28-day mortality. However, additional methods for determining the efficacy may have benefits. The purpose of this study was to search a useful indicator of anticoagulant therapy in patients with sepsis with disseminated intravascular coagulation (DIC). Data from 323 patients with sepsis with coagulopathy treated with antithrombin supplementation were analyzed. The changes in the Sequential Organ Failure Assessment (Δ SOFA) score, the overt-DIC (Δ overt-DIC) score, and the Japanese Society for Acute Medicine DIC (Δ JAAM DIC) score from baseline to day 7 were retrospectively analyzed in relation to the 28-day mortality. Significant correlations were found between the 28-day mortality and Δ SOFA, Δ overt-DIC score, and Δ JAAM DIC score. The accuracy of the prediction was higher for Δ SOFA (80.5%) than for Δ overt-DIC (66.7%, P < .001). The areas under the curve for mortality calculated using a receiver operating characteristic curve analysis were 0.812 for Δ SOFA, 0.655 for Δ overt-DIC, and 0.693 for Δ JAAM DIC. The mortality rate was significantly lower among cases with an improved SOFA score compared to those without an improvement. The Δ SOFA had the strongest association with the 28-day mortality in patients with sepsis and DIC.

Keywords: antithrombin; clinical practice; disseminated intravascular coagulation; sepsis; sequential organ failure assessment score.

Figure 1.

Comparison of the receiver operating characteristic (ROC) curves for the Δ SOFA score, the Δ overt-DIC score, and the Δ JAAM DIC score for mortality. The ROC curves for 28-day mortality of the changes from baseline to day 7 in the modified sequential organ failure assessment (SOFA) score (solid line), the overt-DIC score (dotted line), and the Japanese Association for Acute Medicine (JAAM) DIC score (dashed line) are shown. The areas under the ROC curves (AUCs) for the 3 indicators were 0.812, 0.655, and 0.693, respectively.