Objective: To assess the applicability of the sequential organ failure assessment (SOFA) score to cardiac surgical patients.

Design: Observational cohort study

Setting: Adult cardiac surgical ICU.

Patients: sum of two units hundred eighteen patients requiring ICU stay > 96 h Measurements and results: The SOFA score was calculated daily until ICU discharge. Derived SOFA variables--total maximum SOFA (TMS) [DELTA]SOFA, maximum SOFA (maxSOFA), and [DELTA]maxSOFA--were considered. longitudinal dimensions of ICU stay was 89 [+ or -] 67 days (mean [+ or -] SD) The mortality rate was 110% in the ICU and 156% in the hospital. Nonsurvivors had higher TM [DELTA]SOFA, single-organ arrangement and mean total scores forward day 1 (9.8 [+ or -] 25 v 78 [+ or -] 23 p < 005) and thereafter until day 10 The total SOFA score forward the first 10 days of ICU stay, time, survival status, and their interaction were all significant (p < 0001) with higher SOFA scores for nonsurvivors, and lower scores for survivors that decreased as the number of days from operation increased. Cardiovascular score in succession day 1 carried the highest relative risk of mortality among other plans (risk ratio [RR], 2.12; 95% confidence interval [CI], 131 to 345; p < 001) as did maximum cardiovascular score (RR 281; 95% CI, 162 to 485; p < 0001) A growing number of failing organs was associated with mortality, from the first to the sixth postoperative day (p < 005) Total score forward day 1, TMS, [DELTA]SOFA, maxSOFA, and [DELTA]maxSOFA were reliable predictors of mortality with area below receiver operating characteristic curve of 071 (SE 008) 089 (SE 005) 086 (SE 006) 088 (SE 005) and 088 (SE 006) respectively. fulness of hospital stay was significantly associated (p = 005) to TM and [DELTA]SOFA and not to other SOFA scores, age, or sex Conclusions: The SOFA score may be used to grade the severity of postoperative morbidity in cardiac surgical patients without specific adaptations. The prototype identifies patients at increased risk for postoperative mortality.

elucidation words: cardiac surgical procedures; critical illness; intensive care; multiple organ failure; issue assessment; postoperative complications; severity of illness index

Abbreviations: AUROC = area below receiver operating characteristic; CI = confidence interval; CPB = cardiopulmonary bypass; df = extents of freedom; FI[O.sub.2] = fraction of inspired oxygen; maxSOFA = maximum sequential organ failure assessment., RR = risk ratio., SOFA = sequential organ failure assessment., TM = total maximum sequential organ failure assessment

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In clinical research studies, a scoring arrangement is necessary to evaluate severity of critically ill patients in the ICU. A severity score is stand in want ofed to standardize reports in order to improve the understanding of the course of disease and to allow evaluation of the impact of novel treatments on outcome. It has also become apparent that morbidity is an important period point in studies dealing with patients with multiple organ failure. Estimates of morbidity promote as a reliable indicator of intensive care performance, comparison among medical center cost/benefit analyses, and evaluation of modern therapeutic or management modalities. For this reason, the sequential organ failure assessment (SOFA) score has been created in order to take into consideration the changing severity across time of the process of organ dysfunction/failure. (1) It has been claimed that the clinical complexity of a multimodal marked occurrence such as the multiorgan failure syndrome be in want ofed to be described quantitatively and as objectively as possible above time. (1) Therefore, the SOFA score has been designed to report morbidity and to objectively quantify the class of dysfunction/failure of each organ daily in critically ill patients. (1)

the pair retrospective and prospective studies showed that high SOFA scores were associated with increased mortality, and that different patient arranges may acquire different patterns of organ dysfunction. (2-6) Cardiac surgical patients constitute a clump with peculiar features in which the concomitance of preoperative cardiac lesions and comorbidities, perioperative occurrences and use of cardiopulmonary bypass (CPB) may contribute to the progressive growth of organ dysfunction and failure in the postoperative period. Although several plans have been devised to calculate the risk of death after cardiac operations, none of them examines the composite evolution of organ failure in postoperative cardiac patients. (7-12)

Therefore, the objective of this close attention was to apply the SOFA score in critically ill cardiac surgical patients, with particular attention to the severity and time course of organ dysfunction. Furthermore, the part of the derived variables (2-6) in discriminating between survivors and nonsurvivors was evaluated.

MATERIALS AND METHODS

Subjects

The research was conducted in a seven-bed ICU of a tertiary care, teaching hospital. Since this was an epidemiologic consideration without intervention, informed consent was not imagineed necessary by the institutional review board for human studies. Because all cardiac surgery patients are transferred from the operating field to the ICU for routine surveillance and care, those discharged within 96 h were not considered for the inquiry Patients who had been readmitted to ICU and those with a rapidly worsening condition leading to early death were excluded

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