ArticlePloS one2024
SOFA score performs worse than age for predicting mortality in patients with COVID-19.
Article in PloS one, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Four-organ SOFA score as a potential tool to triage use of continuous kidney replacement therapy in COVID-19 patients with acute kidney injury: a retrospective two-center study.Renal failure · 2026Article
- Development and validation of a nomogram based on immune-inflammation-nutrition indictors for predicting 28-day mortality in sepsis patients with severe fungal pneumonia.Frontiers in cellular and infection microbiology · 2026Article
- Severe COVID-19 in Non-Smokers: Predictive Factors and Outcomes.Healthcare (Basel, Switzerland) · 2025Article
- External Validation of the Predictive Accuracy of Clinical and Immunological Scores in COVID-19 Outcomes in a Retrospective Cohort Study.Biomedicines · 2024Article
- Association between Age-Adjusted Endothelial Activation and Stress Index and Intensive Care Unit Mortality in Patients with Severe COVID-19.Tuberculosis and respiratory diseases · 2024Article
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Authors and funding
9 authors.
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Abstract
The use of the Sequential Organ Failure Assessment (SOFA) score, originally developed to describe disease morbidity, is commonly used to predict in-hospital mortality. During the COVID-19 pandemic, many protocols for crisis standards of care used the SOFA score to select patients to be deprioritized due to a low likelihood of survival. A prior study found that age outperformed the SOFA score for mortality prediction in patients with COVID-19, but was limited to a small cohort of intensive care unit (ICU) patients and did not address whether their findings were unique to patients with COVID-19. Moreover, it is not known how well these measures perform across races. In this retrospective study, we compare the performance of age and SOFA score in predicting in-hospital mortality across two cohorts: a cohort of 2,648 consecutive adult patients diagnosed with COVID-19 who were admitted to a large academic health system in the northeastern United States over a 4-month period in 2020 and a cohort of 75,601 patients admitted to one of 335 ICUs in the eICU database between 2014 and 2015. We used age and the maximum SOFA score as predictor variables in separate univariate logistic regression models for in-hospital mortality and calculated area under the receiver operator characteristic curves (AU-ROCs) and area under precision-recall curves (AU-PRCs) for each predictor in both cohorts. Among the COVID-19 cohort, age (AU-ROC 0.795, 95% CI 0.762, 0.828) had a significantly better discrimination than SOFA score (AU-ROC 0.679, 95% CI 0.638, 0.721) for mortality prediction. Conversely, age (AU-ROC 0.628 95% CI 0.608, 0.628) underperformed compared to SOFA score (AU-ROC 0.735, 95% CI 0.726, 0.745) in non-COVID-19 ICU patients in the eICU database. There was no difference between Black and White COVID-19 patients in performance of either age or SOFA Score. Our findings bring into question the utility of SOFA score-based resource allocation in COVID-19 crisis standards of care.
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