Delta Sequential Organ Failure Assessment Within the First 24 Hours as a Predictor of Mortality in Critically Ill Surgical Patients

Introduction: Early identification of critically ill surgical patients at high risk of mortality is essential for timely intervention. The Sequential Organ Failure Assessment (SOFA) score is widely used to assess organ dysfunction, and dynamic changes in SOFA may provide better prognostic value than a single measurement. This study aimed to evaluate the role of change in SOFA score within the first 24 hours (ΔSOFA) as a predictor of mortality in surgically critically ill patients with shock and multiple organ dysfunction syndrome (MODS).

Methods: This retrospective observational study was conducted in a tertiary care intensive care unit (ICU). Adult surgical patients (≥18 years) with shock and MODS were included. SOFA scores were calculated at admission and at 24 hours. ΔSOFA was determined as the difference between these values, and patients were categorized into ΔSOFA 2-4 and ΔSOFA >4 groups. The primary outcome was in-hospital mortality. Statistical analysis was performed using Fisher’s exact test, with p < 0.05 considered significant.

Results: A total of 200 patients were included. The overall mortality rate was 40%. Among patients with ΔSOFA 2-4 (n = 68), mortality was 58.8%, whereas patients with ΔSOFA >4 (n = 34) had a significantly higher mortality of 94.1% (p = 0.002). Patients with ΔSOFA >4 had markedly higher odds of mortality compared to those with ΔSOFA 2-4 (odds ratio (OR) = 11.2, 95% confidence interval (CI): 2.5-50.8). Most patients had severe disease at admission, with high baseline SOFA scores and multi-organ involvement. Infectious etiology was the predominant cause of MODS.

Conclusion: An increase in SOFA score within the first 24 hours is strongly associated with mortality in surgically critically ill patients. ΔSOFA is a simple, objective, and dynamic tool that can aid in early risk stratification and guide clinical decision-making in the ICU.