Prognostic value of the sequential organ failure assessment score (SOFA) for early postoperative monitoring of heart transplanted patients

Aims: SOFA has an increasing role in the prediction of mortality and morbidity in cardiac surgical patients. As patients after HTx receive inotropes early postoperatively due to the pathophysiology of heart transplantation, identifying patients at high risk of mortality may be difficult. We therefore evaluated the application of SOFA in this setting.

Methods: We retrospectively studied 126 consecutive heart transplant recipients (age: median 47, 12–70 years). The SOFA was calculated postoperatively and daily until intensive care unit (ICU) discharge or for a maximum of 7 days. C-reactive protein (CRP) values and white blood cell count (WBC) were reviewed. Lengths of ICU stay (L-ICU) and 30-day mortality were assessed.

Results: From the 1st until the 7th postoperative day only SOFA values were significantly higher in non-survivors (12.5%) than in survivors (p<0.001). For SOFA, area under the receiver operating characteristic curve (ROC-AUC) for risk of 30-day mortality at ICU admission was 0.90 (95% CI 0.83 to 0.98). In survivors the maximum of SOFA correlated significantly with the L-ICU.

The main organ dysfunction responsible for the higher SOFA in non-survivors was renal dysfunction, followed by thrombocytopenia and respiratory dysfunction.

Conclusion: Although patients after HTx need catecholamines in the early postoperative period, SOFA can be used to grade the severity of morbidity and to identify the risk of 30-day mortality. Renal function and thrombocytopenia are to be focused on in this condition. As an independent score, SOFA is therefore helpful in early therapeutic decision making in heart transplanted patients.