Organ dysfunction as determined by the SOFA score is associated with prognosis in patients with acute traumatic spinal cord injury above T6

• Published in: Spinal cord Vol. 60; no. 3; pp. 274 - 280
• Main Authors: Esmorís-Arijón, Inés, Galeiras, Rita, Montoto Marqués, Antonio, Pértega Díaz, Sonia
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-03-2022; Nature Publishing Group
• Subjects: 692/308/174; 692/308/409; Anatomy; APACHE; Biomedical and Life Sciences; Biomedicine; Evaluation; Human Physiology; Humans; Independent variables; Intensive Care Units; Medical prognosis; Mortality; Multiple Organ Failure - diagnosis; Multiple Organ Failure - etiology; Multivariate analysis; Neurochemistry; Neuropsychology; Neurosciences; Organ Dysfunction Scores; Patients; Prognosis; Regression models; Retrospective Studies; ROC Curve; Spinal cord injuries; Spinal Cord Injuries - complications; Spinal Cord Injuries - diagnosis; Survival
• DOI: 10.1038/s41393-021-00701-w
• EISSN: 1476-5624
• ISSN: 1362-4393

Study design
This is a retrospective, observational study.
Objectives
To evaluate organ dysfunction in patients with an acute traumatic spinal cord injury (ATSCI) above T6 using the Sequential Organ Failure Assessment (SOFA) score to determine its association with mortality.
Setting
The study was performed at the intensive care unit (ICU) of a tertiary hospital in the northwest of Spain.
Methods
The study included 241 patients with an ATSCI above T6 who had been admitted to the ICU between 1998 and 2017. A descriptive analysis of all variables collected was performed to compare the survivors with the non-survivors. In addition, a logistic regression model was used in the multivariate analysis to identify variables that were independently associated with mortality.
Results
The results revealed significant differences between the survivors and non-survivors in terms of their age, Charlson Comorbidity Index, Glasgow Coma Scale score on admission, APACHE II score, SOFA score on day 0 and day 4, and delta SOFA 4–0 (ΔSOFA 4–0). The results of this multivariate analysis identified the following variables as independent predictors of intra-ICU mortality: age (OR = 1.05; 95% CI: 1. 01–1.08), SOFA score on day 0 (OR = 1.42; 95% CI: 1.13–1.78), ΔSOFA 4–0 (OR = 1.53; 95% CI: 1.25–1.87), and fluid balance on day 4 (OR = 1.16; 95% CI: 1.00–1.35).
Conclusions
The SOFA score is useful for evaluating organ dysfunction in patients with an ATSCI above T6. After adjusting the analysis for conventional variables, organ dysfunction on admission, changes in organ function between day 4 and day 0 (ΔSOFA 4–0), and fluid balance on day 4 were seen to be independently associated with mortality in our study.