Prognostic ability of the sequential organ failure assessment score in accidental hypothermia: a multi-institutional retrospective cohort study

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Yoshiki Okumura¹  Nobunaga Okada²  Makoto Watanabe²  Tasuku Matsuyama²  Yasuyuki Sumida³  Nobuhiro Miyamae⁴  Takaaki Jo⁵  Yoshihiro Fujimoto⁶  Yohei Okada⁷  Ryoji Iiduka⁷  Kenji Kandori⁷  Ayumu Tsuruoka⁸  Masahiro Nozawa⁹  Naoki Ehara^1,10  Tetsuhisa Kitamura^1,11  Sachiko Morita^1,12 

[1] Department of Emergency Medicine, Fukuchiyama City Hospital;Department of Emergency Medicine, Kyoto Prefectural University of Medicine;Department of Emergency Medicine, North Medical Center, Kyoto Prefectural University of Medicine;Department of Emergency Medicine, Rakuwa-kai Otowa Hospital;Department of Emergency Medicine, Uji-Tokushukai Medical Center;Department of Emergency Medicine, Yodogawa Christian Hospital;Department of Emergency and Critical Care Medicine, Japanese Red Cross Society, Kyoto Daini Hospital;Department of Emergency and Critical Care Medicine, Kyoto Min-Iren Chuo Hospital;Department of Emergency and Critical Care Medicine, Saiseikai Shiga Hospital;Department of Emergency, Japanese Red Cross Society, Kyoto Daiichi Red Cross Hospital;Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University;Senri Critical Care Medical Center, Saiseikai Senri Hospital;

关键词: Accidental hypothermia;    Environmental emergency;    Mortality;    The sequential organ failure assessment;    The systemic inflammatory response syndrome;   

DOI  :  10.1186/s13049-019-0681-8

来源: DOAJ

【 摘 要 】

Abstract Background Severe accidental hypothermia (AH) is life threatening. Thus, prognostic prediction in AH is essential to rapidly initiate intensive care. Several studies on prognostic factors for AH are known, but none have been established. We clarified the prognostic ability of the Sequential Organ Failure Assessment (SOFA) score in comparison with previously reported prognostic factors among patients with AH. Methods The J-point registry database is a multi-institutional retrospective cohort study for AH in 12 Japanese emergency departments. From this registry, we enrolled patients who were treated at the intensive care unit (ICU) in various critical care medical centers. In-hospital mortality was the primary outcome. We investigated the discrimination ability of each candidate prognostic factor and the in-hospital mortality by applying the logistic regression models with areas under the receiver operating characteristic curve (AUROC) with 95% confidence interval (CI). Results Of the 572 patients with AH registered in the J-point registry, 220 were eligible for the analyses. The in-hospital mortality was 23.2%. The AUROC of the SOFA score (0.80; 95% CI: 0.72–0.86) was the highest among all factors. The other factors were serum potassium (0.65; 95% CI: 0.55–0.73), lactate (0.67; 95% CI: 0.57–0.75), quick SOFA (qSOFA) (0.55; 95% CI: 0.46–0.65), systemic inflammatory response syndrome (SIRS) (0.60; 95% CI: 0.50–0.69), and 5A severity scale (0.77; 95% CI: 0.68–0.84). Discussion Although serum potassium and lactate had relatively good discrimination ability as mortality predictors, the SOFA score had slightly better discrimination ability. The reason is that lactate and serum potassium were mainly reflected by the hemodynamic state; conversely, the SOFA score is a comprehensive score of organ failure, basing on six different scores from the respiratory, cardiovascular, hepatic, coagulation, renal, and neurological systems. Meanwhile, the qSOFA and SIRS scores underestimated the severity, with low discrimination abilities for mortality. Conclusions The SOFA score demonstrated better discrimination ability as a mortality predictor among all known prognostic factors in patients with AH.

【 授权许可】

Unknown