Addition of HbA1c to SOFA score for predicting outcomes in diabetic patients with sepsis and septic shock

Abstract

Sepsis is a common cause of admissions into intensive care units (ICU’s). SOFA (sequential organ failure assessment) score has been validated as a prognostic marker in sepsis and there’s a good correlation between SOFA scoring and mortality of patients. Diabetes is a well-known predisposing factor for sepsis and we studied whether addition of HbA1c to SOFA score was helpful in predicting outcomes in diabetic patients with sepsis and septic shock. H-SOFA max score (HbA1c score added to maximum SOFA measured on any day of hospital stay) was the best predictor for in-hospital mortality. The mean H-SOFA (Max) score in the died (in-hospital mortality) group was 12.21 (±2.78), and in the discharged group was 5.49 (±2.68). Next best predictor was H-SOFA score (HbA1c score added to SOFA score at admission), followed by SOFA score. All the scores had a positive correlation with length of ICU stay. HbA1c (indicator of glycemic control) was helpful in predicting mortality when combined with the SOFA score (but not by itself). These scores may therefore be helpful to physicians and intensivists for prognostication of the patient and during counselling of the relatives, including end of life discussions.

Keywords

• sepsis
• sequential organ failure
• sofa score
• hba1c
• diabetes mellitus
• mortality