SOFA score is superior to APACHE-II score in predicting the prognosis of critically ill patients with acute renal injury undergoing continuous renal replacement therapy

Background: Acute renal injury (AKI) is the most common cause of organ failure in multiple organ dysfunction syndrome and is associated with higher mortality, especially for patients requiring continuous renal replacement therapy (CRRT). At present, no effective approaches are in place to predict the prognosis of patients with AKI undergoing CRRT. Methods: A retrospective cohort study was carried to determine whether sequential organ failure assessment (SOFA) score may be a more valuable prognostic indicator than acute physiology and chronic health evaluation II (APACHE-II) score in patients with AKI undergoing CRRT. The multivariate analysis, sensitivity analysis, receiver operating characteristics (ROC) curve and decision curve analysis (DCA) were performed to determine the predictive value of SOFA and APACHE-II scores on 28- and 90-day mortality. Results: From January 2009 to September 2016, a total of 1128 cases were included. Multivariate logistic regression analysis showed that both APACHE-II and SOFA scores were associated with 28- and 90-day mortality of patients with AKI undergoing CRRT. The adjusted odds ratios (ORs) for SOFA and APACHE-II scores associated with 28-day mortality were 1.38 (1.27, 1.51) and 1.04 (1.01, 1.07), respectively, and the adjusted ORs for SOFA and APACHE-II scores associated with 90-day mortality were 1.40 (1.28, 1.52) and 1.04 (1.01, 1.07), respectively. decision curve analysis and receiver operating characteristics analyses showed that SOFA had a higher prediction accuracy than APACHE-II for 28- and 90-day mortality. The AUCs of SOFA and APACHE-II for 28-day mortality were 0.70 (0.67, 0.73) and 0.62 (0.58, 0.65), and for 90-day mortality, the AUCs were 0.71 (0.68, 0.78) and 0.62 (0.58, 0.65), respectively. Conclusion: SOFA score revealed higher accuracy than APACHE-II score in predicting the prognosis of critically ill patients with AKI undergoing CRRT.