• Elie Sarraf, Alireza Vafaei Sadr, Vida Abedi, and Anthony S Bonavia.
• Department of Anesthesiology and Perioperative Medicine, Penn State Milton S Hershey Medical Center, Hershey, PA 17033, USA.
• J Crit Care. 2024 Oct 1; 83: 154857154857.

BackgroundThe Sequential Organ Failure Assessment (SOFA) score monitors organ failure and defines sepsis but may not fully capture factors influencing sepsis mortality. Socioeconomic and demographic impacts on sepsis outcomes have been highlighted recently.ObjectiveTo evaluate the prognostic value of SOFA scores against demographic and social health determinants for predicting sepsis mortality in critically ill patients, and to assess if a combined model increases predictive accuracy.MethodsThe study utilized retrospective data from the MIMIC-IV database and prospective external validation from the Penn State Health cohort. A Random Forest model incorporating SOFA scores, demographic/social data, and the Charlson Comorbidity Index was trained and validated.FindingsIn the MIMIC-IV dataset of 32,970 sepsis patients, 6,824 (20.7%) died within 30 days. A model including demographic, socioeconomic, and comorbidity data with SOFA scores improved predictive accuracy beyond SOFA scores alone. Day 2 SOFA, age, weight, and comorbidities were significant predictors. External validation showed consistent performance, highlighting the importance of delta SOFA between days 1 and 3.ConclusionAdding patient-specific demographic and socioeconomic information to clinical metrics significantly improves sepsis mortality prediction. This suggests a more comprehensive, multidimensional prognostic approach is needed for accurate sepsis outcome predictions.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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