Racial disparities in the SOFA score among patients hospitalized with COVID-19
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Abstract
Sequential Organ Failure Assessment (SOFA) score predicts probability of in-hospital mortality. Many crisis standards of care suggest the use of SOFA scores to allocate medical resources during the COVID-19 pandemic.
Research question
Are SOFA scores elevated among Non-Hispanic Black and Hispanic patients hospitalized with COVID-19, compared to Non-Hispanic White patients?
Study design and methods
Retrospective cohort study conducted in Yale New Haven Health System, including 5 hospitals with total of 2681 beds. Study population drawn from consecutive patients aged ≥18 admitted with COVID-19 from March 29 th to August 1 st , 2020. Patients excluded from the analysis if not their first admission with COVID-19, if they did not have SOFA score recorded within 24 hours of admission, if race and ethnicity data were not Non-Hispanic Black, Non-Hispanic White, or Hispanic, or if they had other missing data. The primary outcome was SOFA score, with peak score within 24 hours of admission dichotomized as <6 or ≥6.
Results
Of 2982 patients admitted with COVID-19, 2320 met inclusion criteria and were analyzed, of whom 1058 (45.6%) were Non-Hispanic White, 645 (27.8%) were Hispanic, and 617 (26.6%) were Non-Hispanic Black. Median age was 65.0 and 1226 (52.8%) were female. In univariate logistic screen and in full multivariate model, Non-Hispanic Black patients but not Hispanic patients had greater odds of an elevated SOFA score ≥6 when compared to Non-Hispanic White patients (OR 1.49, 95%CI 1.11–1.99).
Interpretation
Given current unequal patterns in social determinants of health, US crisis standards of care utilizing the SOFA score to allocate medical resources would be more likely to deny these resources to Non-Hispanic Black patients.
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SciScore for 10.1101/2021.03.31.21254735: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The study was approved by the Yale University Human Subjects Committee (study number 2000028081). Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Experimental Models: Organisms/Strains Sentences Resources Patients were excluded from the analysis if they did not have a SOFA score recorded within 24 hours of admission, if it was not their first admission with COVID-19, or if their race and ethnicity data were not Non-Hispanic Black, Non-Hispanic White, or Hispanic (Fig 1). Non-Hispanic Whitesuggested: NoneResults from OddPub: We did not detect open data. We also did not detect …
SciScore for 10.1101/2021.03.31.21254735: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The study was approved by the Yale University Human Subjects Committee (study number 2000028081). Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Experimental Models: Organisms/Strains Sentences Resources Patients were excluded from the analysis if they did not have a SOFA score recorded within 24 hours of admission, if it was not their first admission with COVID-19, or if their race and ethnicity data were not Non-Hispanic Black, Non-Hispanic White, or Hispanic (Fig 1). Non-Hispanic Whitesuggested: NoneResults from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:(34) Another limitation is that we did not investigate potential disparities in SOFA scores in other marginalized populations. Future research is needed to examine the effects of disability, psychiatric comorbidities, substance use disorders, unstable housing, or incarceration on SOFA scores. In conclusion, Non-Hispanic Black patients admitted to hospitals with COVID-19 had increased odds of an elevated SOFA score ≥6 within the first 24-hours of admission. Therefore, published triage protocols utilizing the SOFA score to allocate scarce medical resources would be more likely to deny Non-Hispanic Black patients scarce medical resources such as ventilators and ICU beds if implemented during the COVID-19 pandemic. Governments and healthcare systems should prospectively consider and implement measures to reduce systemic racism, protect marginalized populations, and promote racial and ethnic equity the pandemic.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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