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To the Editor: Dr Ferreira and colleagues¹ concluded that sequential assessment of multiple organ dysfunction (MOD) is a good predictor of mortality in critically ill patients, with the highest and the mean Sequential Organ Failure Assessment (SOFA) scores being particularly prognostic. However, their study raises some questions about the definition of mortality, possible factors causing bias, and interpretation of -SOFA (differences between subsequent scores) results.

First, the mortality end point (hospital or intensive care unit [ICU]) was not clearly mentioned. Most of the mortality prediction models use in-hospital mortality, which better reflects the total performance of the institution but is more difficult to predict. Second, it is possible that if the physicians suspected that daily SOFA scores were associated with mortality,² this might have interfered with the decision-making process itself. Third, one possible bias in highest and mean SOFA models could be the use of scores near the time of . . . [Full Text of this Article]

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Serial Evaluation of the SOFA Score to Predict Outcome in Critically Ill Patients
Flavio Lopes Ferreira, Daliana Peres Bota, Annette Bross, Christian Mélot, and Jean-Louis Vincent
JAMA. 2001;286(14):1754-1758.
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