#3860 Predicting ICU outcomes in trauma patients: the prognostic value of SOFA score and AKI severity

Abstract Background and Aims Critically ill trauma patients admitted to the intensive care unit (ICU) experience significant morbidity and mortality, often driven by multi-organ dysfunction and acute kidney injury (AKI). AKI is a common and severe complication that contributes to poor outcomes, yet its prognostic significance in trauma-related ICU mortality remains incompletely understood. This study aimed to investigate the relationship between organ dysfunction, AKI severity, and ICU mortality in a tertiary trauma center to improve risk stratification and clinical management strategies. Method This prospective observational study was conducted over nine months, enrolling 120 trauma patients admitted to the ICU. Organ dysfunction was assessed using daily Sequential Organ Failure Assessment (SOFA) scores, while AKI was classified according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The association between SOFA scores, AKI severity, and hemodynamic parameters with ICU mortality was analyzed using logistic regression, receiver operating characteristic (ROC) curve analysis, and Youden's J statistic. Results The cohort had a mean age of 54.5 years (±19.5 SD), with most patients being male (84.7%). Surgical interventions were performed in 13.9%, while critical care interventions included intubation (70.8%), inotropic drugs (19.4%), and nephrotoxic agents (9.7%). AKI occurred in 40.28% (60 patients) of patients, classified as KDIGO Stage I (23/60, 37.93 %), Stage II (25/60, 41.38 %), and Stage III (12/60, 20.69 %). Among the 120 patients, 70 (58.33%) died during ICU admission, with 80.95% (57/70) of deceased patients having AKI at the time of death, highlighting a strong association between renal dysfunction and mortality. After adjusting for age, SOFA score, injury severity score (ISS), and mean arterial pressure (MAP), AKI emerged as an independent predictor of mortality, with affected patients showing a 2.31-fold increased risk of death (RR: 2.31) and 5.25 times higher odds of mortality (OR: 5.25, P = 0.006) compared to non-AKI patients. Organ dysfunction severity, as measured by the maximum daily SOFA score, was a strong predictor of ICU mortality (AUC = 0.84, 95% CI: 0.75–0.93). A SOFA score of ≥8 was identified as the optimal cutoff, significantly increasing mortality risk (Fig. 1). Furthermore, higher SOFA scores were strongly associated with severe AKI (KDIGO Stage II-III), with each 1-point increase in SOFA score raising the odds of severe AKI by 27.5% (OR: 1.28, 95% CI: 1.08–1.50, P = 0.004) (Fig. 2). Additionally, MAP was marginally associated with AKI duration (P = 0.054), suggesting that lower MAP values may contribute to prolonged renal impairment, emphasizing the role of hemodynamic stability in ICU outcomes. Conclusion This study demonstrates that SOFA scores strongly predict ICU mortality and AKI severity, with a SOFA threshold of 8 serving as an effective mortality cutoff. The high prevalence of AKI among deceased patients underscores its critical role in ICU outcomes, necessitating early identification and intervention. Hemodynamic monitoring and AKI risk assessment should be integrated into ICU protocols to mitigate mortality and renal dysfunction in critically ill trauma patients. These findings highlight the urgent need for multidisciplinary strategies focused on organ dysfunction management and renal protection to improve survival in ICU trauma populations.