Serial SOFA Outperforms APACHE II in Predicting 30-Day Mortality among Patients with Sepsis and Multi-Organ Dysfunction Syndrome: A Prospective Observational Study

Abstract

Background: One of the leading causes of death among critically ill patients is still sepsis with multi-organ dysfunction syndrome (MODS). Optimising intensive care management and resource allocation requires early identification of high-risk patients. The relative efficacy of APACHE II and Sequential Organ Failure Assessment (SOFA) scores in predicting mortality in patients with sepsis and MODS remains debatable, despite their widespread usage as prognostic tools. This study compared the predictive accuracy of APACHE II and SOFA scores in determining 30-day mortality.

Methods: From February 2024 and August 2025, a prospective observational study was carried out in the Department of Anaesthesiology at MKCG Medical College in Berhampur. A total of sixty adult patients (≥18 years old) with MODS and sepsis were included. (While SOFA scores were evaluated on Days 1 and 3, and mean SOFA scores were subsequently determined, APACHE II scores were computed within 24 hours of admission.) APACHE II scores were computed within 24 hours of admission, whereas SOFA scores were evaluated on days 1 and 3 to determine the mean SOFA scores. After a 30-day follow-up, patients were classified as either survivors or non-survivors. SPSS and Epi Info were used for statistical analysis; p<0.05 was deemed statistically significant.

Results: Among the 60 patients studied, 22 died, yielding a 30-day mortality rate of 36.7%. Non-survivors had significantly higher APACHE II scores than survivors (25.63±5.78 vs. 16.81±4.52; p<0.05). Similarly, SOFA scores were markedly elevated among non-survivors: Day-1 SOFA (10.68±1.86 vs. 5.18±1.90), Day-3 SOFA (12.09±1.62 vs. 5.44±1.99), and mean SOFA (11.38±1.66 vs. 5.63±1.90) (all p<0.05). Serial SOFA assessment demonstrated superior prognostic utility, with rising Day-3 SOFA scores being strongly associated with mortality. Increased heart rate, respiratory rate, serum sodium, serum creatinine, and serum bilirubin levels, along with lower Glasgow Coma Scale scores, were independently associated with mortality (p<0.05).

Conclusion: Both APACHE II and SOFA scores are significant predictors of 30-day mortality in patients with sepsis and MODS. However, serial SOFA monitoring, particularly the Day-3 SOFA assessment, provides superior prognostic information compared to a single APACHE II measurement. Incorporating serial SOFA evaluation into routine critical care practice may improve risk stratification and clinical decision-making.