UMEM Educational Pearls

Settings: Retrospective study of a national inpatient database (Japan).


  • All patients who were admitted between April 1, 2018 and March 31, 2021 with a SOFA score > 2 on admission day.
  • Propensity score matching using SOFA score at admission was used to group patients according to the first unit of admission. The units of admissions were: ICU, High-dependency unit (HDU, which is also called Intermediate care unit), general ward.

Outcome measurement: Primary outcome was in-hospital mortality, after propensity score matching.

Study Results:

  • There were 19770 patients admitted to the IC, 23066 patients in the HDU and 54,234 patients in the ward.
  • There were no significant differences in in-hospital mortality among cohorts with SOFA scores of 3–5.
  • Patients with SOFA => 6 and admitted to the ICU or HDU were associated with lower mortality than patients with same SOFA score but admitted to the ward (Risk difference -2.3 (95% CI -4.6 to -0.1, P=0.041).
  • Patients who had SOFA > 12 and was admitted to the ICU group were associated with significantly lower in-hospital mortality than those with similar SOFA score but was admitted to the HDU (Risk difference -4.3, 95% CI -7.5 to -1.0, P = 0.010)


  • Most of the high SOFA scores among ICU patients were due to norepinephrine or mechanical ventilation.
  • Patients with SOFA 2-5 and were admitted to the ICU/HDU were associated with higher mortality than those admitted to the ward. This was mostly from patients who needed intensive monitoring, and not support for organ failure.
  • ICU admission is also associated with certain adverse events (2).


Risk-stratifying patients according to SOFA score is a potential strategy for appropriate admission strategies.



1.Ohbe H, Sasabuchi Y, Doi K, Matsui H, Yasunaga H. Association Between Levels of Intensive Care and In-Hospital Mortality in Patients Hospitalized for Sepsis Stratified by Sequential Organ Failure Assessment Scores. Crit Care Med. 2023 Sep 1;51(9):1138-1147. doi: 10.1097/CCM.0000000000005886. Epub 2023 Apr 28. PMID: 37114933.

2.Corwin GS, Mills PD, Shanawani H, Hemphill RR. Root Cause Analysis of ICU Adverse Events in the Veterans Health Administration. Jt Comm J Qual Patient Saf. 2017 Nov;43(11):580-590. doi: 10.1016/j.jcjq.2017.04.009. Epub 2017 Jul 25. PMID: 29056178.