BRIEF RESEARCH REPORT article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1580643
This article is part of the Research TopicImaging Advances in Acute Intracerebral Hemorrhage and Implications for Therapeutic ApproachesView all 5 articles
Evaluation of the SOFA Score as a Tool to predict DCI-associated Infarctions after spontaneous Subarachnoid Hemorrhage
Provisionally accepted
Elena Kurz1*
Verena Fassl1Carolin Brockmann2
Alicia Schulze3Darius Kalasauskas1Florian Ringel1
Axel Neulen1*- 1Department of Neurosurgery, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
- 2Department of Neuroradiology, University Hospital Mainz, Mainz, Germany
- 3IMBEI, University Hospital Mainz, Mainz, Germany
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Background Delayed cerebral ischemia (DCI)-associated infarctions are a major complication after spontaneous subarachnoid hemorrhage (SAH). Besides cerebral pathophysiological effects, peripheral organ dysfunction has been linked to DCI. The sequential organ failure assessment (SOFA) score is used in intensive care medicine to monitor organ failure. The objective of our study was to compare SOFA score obtained in the first 48h post-SAH, Hunt&Hess (HH), and Word Federation of Neurosurgical Societies (WFNS) scores in predicting DCI-associated infarctions and to identify the most robust parameters within the SOFA score. Methods We retrospectively evaluated SOFA, H&H, and WFNS scores and DCI-associated infarctions in a cohort of 253 SAH patients.Results ROC analysis revealed an AUC of 0.65 for the SOFA score to predict DCI-associated infarctions (H&H: 0.64, WFNS: 0.62). The threshold maximizing the sums of sensitivity and specificity was ≥7 points (sensitivity 0.58, specificity 0.68, PPV 0.20, NPV 0.92). A simplified score using only the three most robust parameters of the SOFA score, GCS, mean arterial pressure, and Horovitz quotient, resulted in an AUC of 0.7.The SOFA score predicted the development of DCI-associated infarctions similar to the established H&H and WFNS scores. A simplified score combining the three most robust parameters of the SOFA score was at least equal to the established scores. Therefore, the SOFA score and our simplified score could be used as an additional tool to identify SAH patients with a high risk for DCI-associated infarctions.
Keywords: Subarachnoid Hemorrhage, SAH, delayed cerebral ischemia, DCI, Sequential Organ Failure Assessment score, SOFA score, clinical
Received: 20 Feb 2025; Accepted: 23 Apr 2025.
Copyright: © 2025 Kurz, Fassl, Brockmann, Schulze, Kalasauskas, Ringel and Neulen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Elena Kurz, Department of Neurosurgery, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
Axel Neulen, Department of Neurosurgery, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
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