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Background  Optimal methods of mortality risk stratification in patients in the cardiac intensive care unit ( CICU ) remain uncertain. We evaluated the ability of the Sequential Organ Failure Assessment ( SOFA ) score to predict mortality in a large cohort of unselected patients in the CICU.    Methods and Results  Adult patients admitted to the  CICU  from January 1, 2007, to December 31, 2015, at a single tertiary care hospital were retrospectively reviewed.  SOFA  scores were calculated daily, and Acute Physiology and Chronic Health Evaluation ( APACHE )‐ III  and  APACHE ‐ IV  scores were calculated on  CICU  day 1. Discrimination of hospital mortality was assessed using area under the receiver‐operator characteristic curve values. We included 9961 patients, with a mean age of 67.5±15.2 years; all‐cause hospital mortality was 9.0%. Day 1  SOFA  score predicted hospital mortality, with an area under the receiver‐operator characteristic curve value of 0.83; area under the receiver‐operator characteristic curve values were similar for the  APACHE ‐ III  score, and  APACHE ‐ IV  predicted mortality ( P >0.05). Mean and maximum  SOFA  scores over multiple  CICU  days had greater discrimination for hospital mortality ( P <0.01). Patients with an increasing  SOFA  score from day 1 and day 2 had higher mortality. Patients with day 1  SOFA  score <2 were at low risk of mortality. Increasing tertiles of day 1  SOFA  score predicted higher long‐term mortality ( P <0.001 by log‐rank test).    Conclusions  The day 1  SOFA  score has good discrimination for short‐term mortality in unselected patients in the CICU, which is comparable to  APACHE ‐ III  and  APACHE ‐ IV . Advantages of the  SOFA  score over  APACHE  include simplicity, improved discrimination using serial scores, and prediction of long‐term mortality.

Predictive Value of the Sequential Organ Failure Assessment Score for Mortality in a Contemporary Cardiac Intensive Care Unit Population