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Critical Care
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Jaimie Maines, Lauren A. Plante
Because there is no diagnostic test, the clinician should score organ dysfunction according to a standard Sequential Organ Failure Assessment (SOFA) score; see Table 42.6. The SOFA score requires both clinical and laboratory assessment. A 2-point rise from baseline is considered positive; if the baseline is not known, it is assumed to be zero. For the clinician at the bedside, the quick SOFA (qSOFA) score is a screening tool applicable without lab testing (see Table 42.7). A qSOFA score of 2 or 3 requires further evaluation.
Infections
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
As can be predicted from the pathophysiology, the clinical aspects of septic shock comprise fever, systemic hypotension, increasing oxygen requirement to maintain blood PO2, infiltrates on a chest radiograph, generalized oedema, oliguric renal failure, and jaundice. Chronologically there is a division into three stages. In the initial phase, the body's normal compensatory mechanisms maintain critical organ perfusion. This is succeeded by a progressive phase in which tissue hypoperfusion results in organ failure, particularly cardiorespiratory failure, exacerbated by toxic endothelial damage and fluid leakage; metabolic acidosis and renal shutdown occur. Patients can recover from this phase. The final, irreversible, phase follows when critical organ cellular injury is too severe for regeneration or compensation, even if the organs were to be reperfused adequately. Organ dysfunction severity is assessed by various scoring systems that integrates clinical findings, various laboratory results and therapeutic interventions. The scoring system in current use is Sequential Organ Failure Assessment (SOFA), where higher SOFA scores correlate with increasing probability of mortality. The SOFA scoring system takes into account laboratory data (such as PaO2, platelet count, creatinine, and bilirubin levels) in combination with clinical findings. Details of clinical scoring system are beyond the scope of this chapter.
Clinical Data Analytics
Published in Arvind Kumar Bansal, Javed Iqbal Khan, S. Kaisar Alam, Introduction to Computational Health Informatics, 2019
Arvind Kumar Bansal, Javed Iqbal Khan, S. Kaisar Alam
A SOFA score depends upon the combination of six different scores: respiratory (lung), hepatic (liver), cardiovascular (heart), coagulation (blood), renal (kidney) and neurological (nervous system and brain). Respiratory-score is measured using oxygen-content in the blood; Neurological-score is measured using Glasgow coma-scale; Cardiovascular-score is measured using arterial pressure; Hepatic-score is measured using the concentration of bilirubin in liver; Coagulation-score is measured using the density of platelets in the serum. These individual scores vary from 0 (no organ-failure) to +4 (complete organ-failure). The overall SOFA score varies from 0 (no organ-failure) to 3 (multiorgan-failure).
Racism and Bioethics: The Myth of Color Blindness
Published in The American Journal of Bioethics, 2021
Consider the question in the example of the prognosis for a particular medical condition. Imagine two virtually identical patients, with virtually identical medical history, health status, and current clinical condition. One of these hypothetical patients is white and one is Black. Consider further that we were asked to opine on the prognosis for their medical condition. Many models exist with which to create probabilistic predictions of certain clinical outcomes. The most widely used model today is the Sequential Organ Failure Assessment (SOFA) score, a numerical score created from clinical variables; SOFA uses multiple clinical variables, including level of oxygenation, certain blood counts, and measures of kidney function, to predict prognosis in critically ill patients (Raith et al. 2017). In the context of the COVID-19 pandemic, it has been seen as a valuable tool with which to triage the deployment of life-sustaining treatments, including mechanical ventilators and extracorporeal membrane oxygenation (ECMO), in the event of overwhelming numbers of critically ill patients. Patients with a SOFA score predicting better life expectancy, ostensibly based solely on objective, clinical data, would have priority in triage for access to these life-sustaining treatments.
Sepsis-associated encephalopathy and septic encephalitis: an update
Published in Expert Review of Anti-infective Therapy, 2021
Simone C. Tauber, Marija Djukic, Johannes Gossner, Helmut Eiffert, Wolfgang Brück, Roland Nau
The definition of sepsis has been revised in 2016. The main limitation of the previous definition was a strong focus on inflammation [systemic inflammatory response syndrome (SIRS) criteria] and an underestimation of the contribution of the infection to the pathogenesis. Divergent definitions of sepsis, septic shock, and organ dysfunction led to discrepancies in the reported incidence and mortality of sepsis. The new definition requires a documented or at least suspected infection and a ‘life-threatening organ dysfunction caused by a dysregulated host response to infection’ [1]. The Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score is a suitable tool to identify septic patients at risk: an increase of ≥2 points is associated with in-hospital mortality >10%. The SOFA score requires several laboratory tests, which may not be always available rapidly. A shortened version named quick Sequential [Sepsis-related] Organ Failure Assessment (qSOFA) score is a suitable bedside test which can be easily performed by clinicians outside intensive care units (ICUs) without laboratory findings. In a patient with an infection, it relies on 3 points only: altered mental state defined as an abnormal Glasgow Coma Scale, systolic blood pressure, and respiratory rate. Two or more qSOFA points near the onset of infection were associated with a greater risk of death or prolonged intensive care unit stay [2]. The qSOFA score underlines the importance of SAE manifesting as mental abnormalities for the diagnosis and the prognosis of sepsis.
Clinical characteristics and risk factors of male exertional heatstroke in patients with myocardial injury: an over 10-year retrospective cohort study
Published in International Journal of Hyperthermia, 2021
Li Zhong, Jingjing Ji, Conglin Wang, Zhifeng Liu
Multivariate Cox regression analysis indicated that the SOFA score was an independent risk factor for death in patients with severe heat stroke combined with MI. The SOFA score is a measure of multiple organ dysfunction; the higher the score, the more severe the patient [14]. The SOFA score can better reflect and predict the disease severity and prognosis of critically ill patients and is widely used in the clinical practice [15]. In this study, the SOFA score of patients with heatstroke combined with MI was higher in the nonsurvivor group than in the survivor group, indicating that the disease severity was consistent with the fatality rate. The cutoff value for the ROC curve prediction SOFA score was 7.5, with a sensitivity of 91.7% and specificity of 94.6%, suggesting that a SOFA score >7.5 increases the risk of death in patients. Thus, early clinical assessment of the overall condition is crucial in patients with heatstroke and diagnostic prognosis for early cardiac protection. Clinically, for patients with heatstroke, timely SOFA scoring on admission to determine the cutoff point can assess the prognosis of their condition as soon as possible and timely targeted symptomatic and organ protection treatment.