The sequential organ failure assessment score predicts 30-day mortality in a geriatric acute care setting

Background: Several tools to predict patients' survival have been proposed in medical wards, though they are often time consuming and difficult to apply. The Sequential Organ Failure Assessment (SOFA) is a promising tool that has been validated in intensive care units but never in acute medical wards. The aim of this study was to assess whether the SOFA score predicts short-term (30 days) mortality in a population of elderly patients admitted to a geriatric ward.

Methods: This prospective observational cohort study was carried out in a Geriatric Clinic of an Italian teaching hospital. Among 359 patients consecutively and firstly admitted between January and April 2012, we considered eligible those (n = 314) directly admitted from the emergency department. Demographic, functional, and clinical variables were collected. The SOFA score was measured on admission (SOFA-admission) and 48 hours later (SOFA-48h). The vital status of participants was assessed over the 30 days following discharge.

Results: Patients who died at 1-month follow-up were prevalently men, more comorbid, disabled, and undernourished and had higher SOFA scores on admission and at 48 hours than their counterparts. Among all potential predictors of 1-month mortality, the SOFA-48h score was the best, with a score greater than 4 significantly increasing the risk to die during hospitalization or in the 30 days following discharge (odds ratio = 7.030; 95% confidence interval = 3.982-12.409).

Conclusions: The SOFA score, a user-friendly tool used in intensive care units to estimate prognosis, is able to predict 1-month mortality also in patients admitted to an acute geriatric setting.