SOFA Score prognostic performance among patients admitted to High-Dependency Units

BACKGROUND: The aim of this study was to assess prognostic stratification in patients admitted in two Italian Emergency-Department High-Dependency Units (ED-HDU). METHODS: From June 2014, to July 2016, we recorded all patients admitted in the ED-HDU of the Careggi University Hospital and the Vittorio Emanuele University Hospital in a standardized database. Charlson Index and SOFA Score were calculated to evaluate comorbidity burden and severity of organ dysfunction. End-points were HDU and in-hospital mortality rate and need of Intensive Care Unit (ICU) transfer. RESULTS: The overall number of patients admitted in the two Units was 3311, 1822 in Florence and 1489 in Catania. HDU mortality rate was 5% (N.=171); compared with survivors, non-survivors showed a higher SOFA Score (10.0+/-4.2 vs. 3.5+/-2.9, P<0.001) and a higher number of organ dysfunctions (1.6+/-0.9 vs. 0.6+/-0.8, P<0.001). All patients with a SOFA Score in the first and second quartile survived HDU admission (only two non-survivors among patients in the second quartile), while mortality was disproportionally high in the group with a score value in the fourth quartile (0%, 0.2%, 3% and 14%, P<0.001). Presence and number of organ failure, as well as SOFA Score (5.6+/-4.0 vs. 3.4+/-2.8, P<0.001), were significantly higher in patients transferred to ICU than in those admitted in an ordinary ward or discharged. A higher SOFA Score (RR 1.55, 95% CI: 1.47-1.63, P<0.001) was associated with an increased HDU mortality, independent of age and Charlson Index. CONCLUSIONS: SOFA Score showed a good discrimination ability for both HDU - mortality and indication to increase the level of care.