Discriminatory power of organ-specific Sequential Organ Failure Assessment (SOFA) scores: Predictors of maternal mortality in obstetric intensive care units (ICU)
- 1Department of Obstetrics and Gynaecology, King George’s Medical University, Lucknow, Uttar Pradesh, India
- 2Department of Obstetrics and Gynaecology, Rani Durgavati Medical College, Banda, Uttar Pradesh, India
- 3Department of Critical Care, King George’s Medical University, Lucknow, Uttar Pradesh, India
Abstract
Background:: Critically ill obstetric patients in intensive care units (ICUs) present unique challenges, and maternal mortality remains a major concern, particularly in low- and middle-income countries. The Sequential Organ Failure Assessment (SOFA) score, though widely used in general ICUs, has not been adequately studied for its organ-specific discriminatory power in predicting maternal mortality. This study aimed to evaluate the prognostic accuracy of individual organ SOFA sub-scores to improve risk stratification in obstetric critical care.
Methods:: This prospective observational study was conducted over one year in the obstetric ICU of a tertiary center in Northern India. A total of 125 obstetric patients (pregnant or within 42 days postpartum) were enrolled. SOFA sub-scores for respiratory, cardiovascular, hepatic, renal, coagulation, and neurological systems were calculated on admission and throughout ICU stay. Patients were classified into survivors and non-survivors. Associations between individual organ dysfunction and maternal mortality were assessed. Discriminatory accuracy of organ-specific SOFA scores was determined using receiver operating characteristic (ROC) curve analysis.
Results:: Mortality increased proportionally with the number of dysfunctional organs (χ² =39.693; P < 0.001). Escalating organ-specific SOFA scores were significantly associated with maternal mortality. ROC analysis revealed that cardiovascular dysfunction had the highest predictive accuracy (area under the curve [AUC] =0.875), followed by hepatic (AUC = 0.808), respiratory (AUC = 0.804), hematological (AUC = 0.763), and renal (AUC = 0.757) dysfunction.
Conclusion:: Cardiovascular, hepatic, and respiratory SOFA sub-scores provide strong discriminatory power for predicting maternal mortality in Obstetric ICU patients. Incorporating organ-specific SOFA assessments may enhance early risk stratification and guide life-saving interventions in resource-limited settings.
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BibTeX
@article{agrawal2026discriminatory,
title = {{Discriminatory power of organ-specific Sequential Organ Failure Assessment (SOFA) scores: Predictors of maternal mortality in obstetric intensive care units (ICU)}},
author = {Monica Agrawal and Kathipri Nelia and Armin Ahmed and Sujata Deo and Shyam P. Jaiswar},
journal = {Journal of family medicine and primary care},
year = {2026},
month = jul,
doi = {10.4103/jfmpc.jfmpc_2216_25},
url = {https://europepmc.org/article/PMC/PMC13722232},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Discriminatory power of organ-specific Sequential Organ Failure Assessment (SOFA) scores: Predictors of maternal mortality in obstetric intensive care units (ICU)
AU - Monica Agrawal
AU - Kathipri Nelia
AU - Armin Ahmed
AU - Sujata Deo
AU - Shyam P. Jaiswar
PY - 2026
DA - 2026/07/01
JO - Journal of family medicine and primary care
DO - 10.4103/jfmpc.jfmpc_2216_25
UR - https://europepmc.org/article/PMC/PMC13722232
AB - Background:: Critically ill obstetric patients in intensive care units (ICUs) present unique challenges, and maternal mortality remains a major concern, particularly in low- and middle-income countries. The Sequential Organ Failure Assessment (SOFA) score, though widely used in general ICUs, has not been adequately studied for its organ-specific discriminatory power in predicting maternal mortality. This study aimed to evaluate the prognostic accuracy of individual organ SOFA sub-scores to improve risk stratification in obstetric critical care. Methods:: This prospective observational study was conducted over one year in the obstetric ICU of a tertiary center in Northern India. A total of 125 obstetric patients (pregnant or within 42 days postpartum) were enrolled. SOFA sub-scores for respiratory, cardiovascular, hepatic, renal, coagulation, and neurological systems were calculated on admission and throughout ICU stay. Patients were classified into survivors and non-survivors. Associations between individual organ dysfunction and maternal mortality were assessed. Discriminatory accuracy of organ-specific SOFA scores was determined using receiver operating characteristic (ROC) curve analysis. Results:: Mortality increased proportionally with the number of dysfunctional organs (χ² =39.693; P < 0.001). Escalating organ-specific SOFA scores were significantly associated with maternal mortality. ROC analysis revealed that cardiovascular dysfunction had the highest predictive accuracy (area under the curve [AUC] =0.875), followed by hepatic (AUC = 0.808), respiratory (AUC = 0.804), hematological (AUC = 0.763), and renal (AUC = 0.757) dysfunction. Conclusion:: Cardiovascular, hepatic, and respiratory SOFA sub-scores provide strong discriminatory power for predicting maternal mortality in Obstetric ICU patients. Incorporating organ-specific SOFA assessments may enhance early risk stratification and guide life-saving interventions in resource-limited settings.
SN - 2249-4863
SN - 2278-7135
ER -