Is the SOFA score a predictor of hemorrhagic shock in the immediate post-transplant period in patients with short- or medium-term circulatory assist devices?

In the updated 2023 Spanish criteria for urgent heart transplant (HTx) listing, it is recommended to exclude patients with multiorgan failure, with a SOFA score ≥12 serving as an indicator, as this level is associated with mortality rates above 49%. However, there is currently no evidence regarding the prognostic value of the SOFA score in heart transplantation.

To evaluate whether the preoperative SOFA score predicts the development of hemorrhagic shock in the immediate post–heart transplant period among patients supported with short- or medium-term circulatory assist devices.

We conducted a descriptive, retrospective, single-center study including all consecutive patients who underwent urgent HTx with a short- or medium-term circulatory assist device (CAD) between October 2020 and April 2023. We analyzed the correlation between the clinical condition during the last 24 hours before HTx, as assessed by the SOFA score, and the development of hemorrhagic shock (HS) in the immediate post-transplant period.

A total of 14 patients were included, 78.6% (n=11) of whom were male, with a mean age of 55.5 ± 10.2 years. Figure 1 shows the types of CAD used: 57.1% (n=8) were biventricular and 35.7% (n=5) surgical. The mean preoperative SOFA score was 3.6 ± 2.2 (IQR 2.0–5.0), with hemodynamic failure being the most frequent (92.9%, n=13), and a mean VIS score of 9.8 ± 15.6. Figure 1 illustrates the overall distribution of SOFA scores.

Post-transplant HS occurred in 35.7% (n=5) of patients, with a mean SOFA score of 4.0 ± 2.3 in this group versus 3.4 ± 2.2 in patients without HS (p = 0.670). No significant differences were found between groups in any individual SOFA components (Table 1). Although not statistically significant, coagulopathy was four times more frequent in the HS group (40.0% vs. 11.1%, p = 0.505). HS was also four times more frequent in patients with biventricular support (80.0% vs. 20.0%, p = 0.301), although differences were not statistically significant. Mortality was similar between patients with and without HS (20.0% vs. 22.2%, p = 0.999).

Neither the overall SOFA score nor its individual components appeared to be significantly associated with the development of HS in the immediate post-HTx period among patients with short- or medium-term CAD and SOFA scores <12. However, HS appeared to be more frequent among patients with biventricular support and coagulopathy.