ACUITI Score: A Streamlined Alternative to SOFA for ICU Mortality Prediction

Introduction: The Sequential Organ Failure Assessment (SOFA) score is a validated tool for predicting ICU mortality but requires extensive laboratory data, limiting its feasibility in resource-constrained settings. The Acute Care Unit Illness Tracking Instrument (ACUITI) Score, developed by Dr. Ronald Roan, aims to provide comparable predictive accuracy with fewer data inputs. We hypothesize that the ACUITI Score correlates strongly with SOFA and offers incremental sensitivity for mortality risk prediction in ICU patients.


Methods: This observational cohort study, conducted from March 1, 2023, to June 1, 2024, included 996 consecutive ICU patients at a 505-bed community hospital in Birmingham, Alabama. ACUITI and SOFA scores were calculated on admission and every 24 hours until discharge. The ACUITI Score (0–10) assesses respiratory, cardiovascular, renal, and neurological domains, while SOFA (0–24) evaluates six organ systems. Pearson correlation and Receiver Operating Characteristic (ROC) curves with Area Under the Curve (AUC) calculations using DeLong’s test assessed the correlation and predictive accuracy for mortality. Incremental ACUITI score changes were analyzed for mortality risk.


Results: The cohort (55% male, mean age 64.5 years, 18.5% mortality) showed a strong correlation between ACUITI and SOFA scores (r = 0.868). AUC values were 0.87 for ACUITI and 0.90 for SOFA, indicating comparable predictive accuracy. Incremental ACUITI score increases were associated with higher mortality (28.13% in 327 patients with increased ACUITI vs. 11.19% in 652 without). Outlier analysis revealed cases with low ACUITI (0.0) but high SOFA scores (7–8) where patients survived, suggesting ACUITI’s focus on high-yield parameters avoids overestimating risk.


Conclusions: The ACUITI Score is a practical alternative to SOFA, offering high correlation (r = 0.868) and comparable mortality prediction (AUC 0.87 vs. 0.90) with reduced data requirements. Its incremental sensitivity enhances early detection of deteriorating conditions, making it ideal for community hospitals. ACUITI supports tiered care escalation, improving timely interventions. Further multicenter validation is needed to confirm generalizability.