{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T20:52:47Z","timestamp":1792270367695,"version":"4.4.0"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T00:00:00Z","timestamp":1625097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,7,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Crisis standards of care (CSCs) guide critical care resource allocation during crises. Most recommend ranking patients on the basis of their expected in-hospital mortality using the Sequential Organ Failure Assessment (SOFA) score, but it is unknown how SOFA or other acuity scores perform among patients of different races.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To test the prognostic accuracy of the SOFA score and version 2 of the Laboratory-based Acute Physiology Score (LAPS2) among Black and white patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included Black and white patients admitted for sepsis or acute respiratory failure at 27 hospitals. We calculated the discrimination and calibration for in-hospital mortality of SOFA, LAPS2, and modified versions of each, including categorical SOFA groups recommended in a popular CSC and a SOFA score without creatinine to reduce the influence of race.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>Of 113,158 patients, 27,644 (24.4%) identified as Black. The LAPS2 demonstrated higher discrimination (area under the receiver operating characteristic curve [AUC], 0.76; 95% confidence interval [CI], 0.76\u20130.77) than the SOFA score (AUC, 0.68; 95% CI, 0.68\u20130.69). The LAPS2 was also better calibrated than the SOFA score, but both underestimated in-hospital mortality for white patients and overestimated in-hospital mortality for Black patients. Thus, in a simulation using observed mortality, 81.6% of Black patients were included in lower-priority CSC categories, and 9.4% of all Black patients were erroneously excluded from receiving the highest prioritization. The SOFA score without creatinine reduced racial miscalibration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Using SOFA in CSCs may lead to racial disparities in resource allocation. More equitable mortality prediction scores are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.202012-4383oc","type":"journal-article","created":{"date-parts":[[2021,3,22]],"date-time":"2021-03-22T19:32:00Z","timestamp":1616441520000},"page":"178-186","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":92,"title":["Equitably Allocating Resources during Crises: Racial Differences in Mortality Prediction Models"],"prefix":"10.1093","volume":"204","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2107-2110","authenticated-orcid":false,"given":"Deepshikha Charan","family":"Ashana","sequence":"first","affiliation":[{"name":"Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina"},{"name":"Palliative and Advanced Illness Research Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4585-0714","authenticated-orcid":false,"given":"George L.","family":"Anesi","sequence":"additional","affiliation":[{"name":"Palliative and Advanced Illness Research Center"},{"name":"Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine"},{"name":"Leonard Davis Institute of Health Economics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent X.","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente, Oakland, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel J.","family":"Escobar","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente, Oakland, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Chesley","sequence":"additional","affiliation":[{"name":"Palliative and Advanced Illness Research Center"},{"name":"Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine"},{"name":"Leonard Davis Institute of Health Economics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nwamaka D.","family":"Eneanya","sequence":"additional","affiliation":[{"name":"Palliative and Advanced Illness Research Center"},{"name":"Leonard Davis Institute of Health Economics"},{"name":"Renal-Electrolyte and Hypertension Division"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9588-3819","authenticated-orcid":false,"given":"Gary E.","family":"Weissman","sequence":"additional","affiliation":[{"name":"Palliative and Advanced Illness Research Center"},{"name":"Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine"},{"name":"Leonard Davis Institute of Health Economics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William Dwight","family":"Miller","sequence":"additional","affiliation":[{"name":"Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0553-674X","authenticated-orcid":false,"given":"Michael O.","family":"Harhay","sequence":"additional","affiliation":[{"name":"Palliative and Advanced Illness Research Center"},{"name":"Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine"},{"name":"Leonard Davis Institute of Health Economics"},{"name":"Department of Biostatistics, Epidemiology, and Informatics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott D.","family":"Halpern","sequence":"additional","affiliation":[{"name":"Palliative and Advanced Illness Research Center"},{"name":"Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine"},{"name":"Leonard Davis Institute of Health Economics"},{"name":"Department of Biostatistics, Epidemiology, and Informatics, and"},{"name":"Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,7,15]]},"reference":[{"key":"2026030322005726900_bib1","doi-asserted-by":"crossref","first-page":"e41","DOI":"10.1056\/NEJMp2006141","article-title":"Critical supply shortages: the need for ventilators and personal protective equipment during the COVID-19 pandemic","volume":"382","author":"Ranney","year":"2020","journal-title":"N Engl J Med"},{"key":"2026030322005726900_bib2","doi-asserted-by":"crossref","first-page":"188","DOI":"10.7326\/M20-1738","article-title":"Ventilator triage policies during the COVID-19 pandemic at U.S. hospitals associated with members of the association of bioethics program directors","volume":"173","author":"Antommaria","year":"2020","journal-title":"Ann Intern Med"},{"key":"2026030322005726900_bib3","volume-title":"Crisis standards of care: a systems framework for catastrophic disaster response.","author":"Committee on Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations, Institute of Medicine","year":"2012"},{"key":"2026030322005726900_bib4","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1056\/NEJMsb2005114","article-title":"Fair allocation of scarce medical resources in the time of COVID-19","volume":"382","author":"Emanuel","year":"2020","journal-title":"N Engl J Med"},{"key":"2026030322005726900_bib5","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1001\/jama.2020.5046","article-title":"A framework for rationing ventilators and critical care beds during the COVID-19 pandemic","volume":"323","author":"White","year":"2020","journal-title":"JAMA"},{"key":"2026030322005726900_bib6","author":"White","year":"2020"},{"key":"2026030322005726900_bib7","doi-asserted-by":"crossref","first-page":"1793","DOI":"10.1097\/00003246-199811000-00016","article-title":"Use of the SOFA score to assess the incidence of organ dysfunction\/failure in intensive care units: results of a multicenter, prospective study: working group on \u201csepsis-related problems\u201d of the European Society of Intensive Care Medicine","volume":"26","author":"Vincent","year":"1998","journal-title":"Crit Care Med"},{"key":"2026030322005726900_bib8","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1097\/CCM.0000000000003023","article-title":"The impact of acute organ dysfunction on long-term survival in sepsis","volume":"46","author":"Schuler","year":"2018","journal-title":"Crit Care Med"},{"key":"2026030322005726900_bib9","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1007\/BF01709751","article-title":"The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction\/failure: on behalf of the working group on sepsis-related problems of the European Society of Intensive Care Medicine","volume":"22","author":"Vincent","year":"1996","journal-title":"Intensive Care Med"},{"key":"2026030322005726900_bib10","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1001\/jama.2016.20328","article-title":"Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit","volume":"317","author":"Raith","year":"2017","journal-title":"JAMA"},{"key":"2026030322005726900_bib11","doi-asserted-by":"crossref","first-page":"1754","DOI":"10.1001\/jama.286.14.1754","article-title":"Serial evaluation of the SOFA score to predict outcome in critically ill patients","volume":"286","author":"Ferreira","year":"2001","journal-title":"JAMA"},{"key":"2026030322005726900_bib12","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1001\/jama.2016.0288","article-title":"Assessment of clinical criteria for sepsis: for the third international consensus definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Seymour","year":"2016","journal-title":"JAMA"},{"key":"2026030322005726900_bib13","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1001\/jama.2019.5774","article-title":"Reconsidering the consequences of using race to estimate kidney function","volume":"322","author":"Eneanya","year":"2019","journal-title":"JAMA"},{"key":"2026030322005726900_bib14","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1001\/jama.2020.13378","article-title":"Black kidney function matters: use or misuse of race?","volume":"324","author":"Powe","year":"2020","journal-title":"JAMA"},{"key":"2026030322005726900_bib15","doi-asserted-by":"crossref","first-page":"e16","DOI":"10.1056\/NEJMp2011359","article-title":"Inequity in crisis standards of care","volume":"383","author":"Cleveland Manchanda","year":"2020","journal-title":"N Engl J Med"},{"key":"2026030322005726900_bib16","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.2215\/CJN.12791019","article-title":"Kidney disease, race, and GFR estimation","volume":"15","author":"Levey","year":"2020","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026030322005726900_bib17","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1126\/science.aac4951","article-title":"Science and society: taking race out of human genetics","volume":"351","author":"Yudell","year":"2016","journal-title":"Science"},{"key":"2026030322005726900_bib18","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1056\/NEJMms2004740","article-title":"Hidden in plain sight - reconsidering the use of race correction in clinical algorithms","volume":"383","author":"Vyas","year":"2020","journal-title":"N Engl J Med"},{"key":"2026030322005726900_bib19","article-title":"Race-free biomarkers to quantify kidney function: health equity lessons learned from population-based research","author":"Eneanya","journal-title":"Am J Kidney Dis"},{"key":"2026030322005726900_bib20","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1089\/jpm.2016.0557","article-title":"The paradox of end-of-life hospital treatment intensity among black patients: a retrospective cohort study","volume":"21","author":"Barnato","year":"2017","journal-title":"J Palliat Med"},{"key":"2026030322005726900_bib21","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1007\/s11606-006-0088-x","article-title":"Influence of race on inpatient treatment intensity at the end of life","volume":"22","author":"Barnato","year":"2007","journal-title":"J Gen Intern Med"},{"key":"2026030322005726900_bib22","doi-asserted-by":"crossref","first-page":"335","DOI":"10.4037\/ajcc2010161","article-title":"Differences in level of care at the end of life according to race","volume":"19","author":"Johnson","year":"2010","journal-title":"Am J Crit Care"},{"key":"2026030322005726900_bib23","doi-asserted-by":"crossref","first-page":"2219","DOI":"10.1111\/j.1475-6773.2006.00598.x","article-title":"Racial variation in end-of-life intensive care use: a race or hospital effect?","volume":"41","author":"Barnato","year":"2006","journal-title":"Health Serv Res"},{"key":"2026030322005726900_bib24","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1097\/MLR.0b013e3181589bb6","article-title":"Risk-adjusting hospital inpatient mortality using automated inpatient, outpatient, and laboratory databases","volume":"46","author":"Escobar","year":"2008","journal-title":"Med Care"},{"key":"2026030322005726900_bib25","article-title":"Detecting deteriorating patients in hospital: development and validation of a novel scoring system","author":"Pimentel","journal-title":"Am J Respir Crit Care Med"},{"key":"2026030322005726900_bib26","author":"White","year":"2020"},{"key":"2026030322005726900_bib27","doi-asserted-by":"crossref","first-page":"2012","DOI":"10.1056\/NEJMoa2004500","article-title":"COVID-19 in critically ill patients in the Seattle region - case series","volume":"382","author":"Bhatraju","year":"2020","journal-title":"N Engl J Med"},{"key":"2026030322005726900_bib28","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1001\/jama.2020.4031","article-title":"Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response","volume":"323","author":"Grasselli","year":"2020","journal-title":"JAMA"},{"key":"2026030322005726900_bib29","first-page":"251","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies [in Spanish]","volume":"82","author":"von Elm","year":"2008","journal-title":"Rev Esp Salud Publica"},{"key":"2026030322005726900_bib30","first-page":"1440","article-title":"Association of a novel index of hospital capacity strain with admission to intensive care units","volume-title":"Ann Am Thorac Soc","author":"Anesi","year":"2020"},{"key":"2026030322005726900_bib31","doi-asserted-by":"crossref","first-page":"1599","DOI":"10.1513\/AnnalsATS.201912-912OC","article-title":"Association of an emergency department-embedded critical care unit with hospital outcomes and intensive care unit use","volume":"17","author":"Anesi","year":"2020","journal-title":"Ann Am Thorac Soc"},{"key":"2026030322005726900_bib32","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"2026030322005726900_bib33","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1080\/15265161.2020.1764141","article-title":"Eliminating categorical exclusion criteria in crisis standards of care frameworks","volume":"20","author":"Auriemma","year":"2020","journal-title":"Am J Bioeth"},{"key":"2026030322005726900_bib34","article-title":"The crisis in crisis standards of care","author":"Oxman","journal-title":"Ann Am Thorac Soc"},{"key":"2026030322005726900_bib35","doi-asserted-by":"crossref","first-page":"e1209","DOI":"10.1097\/CCM.0000000000002699","article-title":"Racial disparities in sepsis-related in-hospital mortality: using a broad case capture method and multivariate controls for clinical and hospital variables, 2004-2013","volume":"45","author":"Jones","year":"2017","journal-title":"Crit Care Med"},{"key":"2026030322005726900_bib36","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1164\/rccm.200703-480OC","article-title":"Racial variation in the incidence, care, and outcomes of severe sepsis: analysis of population, patient, and hospital characteristics","volume":"177","author":"Barnato","year":"2008","journal-title":"Am J Respir Crit Care Med"},{"key":"2026030322005726900_bib37","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1097\/CCM.0000000000004246","article-title":"Development and reporting of prediction models: guidance for authors from editors of respiratory, sleep, and critical care journals","volume":"48","author":"Leisman","year":"2020","journal-title":"Crit Care Med"},{"key":"2026030322005726900_bib38","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1097\/JTO.0b013e3181ec173d","article-title":"Receiver operating characteristic curve in diagnostic test assessment","volume":"5","author":"Mandrekar","year":"2010","journal-title":"J Thorac Oncol"},{"key":"2026030322005726900_bib39","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1177\/1536867X0200200307","article-title":"From the help desk: comparing areas under receiver operating characteristic curves from two or more probit or logit models","volume":"2","author":"Cleves","year":"2002","journal-title":"Stata J"},{"key":"2026030322005726900_bib40","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1177\/1536867X1801700414","article-title":"Assessing the calibration of dichotomous outcome models with the calibration belt","volume":"17","author":"Nattino","year":"2017","journal-title":"Stata J"},{"key":"2026030322005726900_bib41","doi-asserted-by":"crossref","first-page":"4051","DOI":"10.1002\/sim.8281","article-title":"The Integrated Calibration Index (ICI) and related metrics for quantifying the calibration of logistic regression models","volume":"38","author":"Austin","year":"2019","journal-title":"Stat Med"},{"key":"2026030322005726900_bib42","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1097\/MLR.0b013e3182881c8e","article-title":"Risk-adjusting hospital mortality using a comprehensive electronic record in an integrated health care delivery system","volume":"51","author":"Escobar","year":"2013","journal-title":"Med Care"},{"key":"2026030322005726900_bib43","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann Intern Med"},{"key":"2026030322005726900_bib44","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.2215\/CJN.00690120","article-title":"Precision in GFR reporting: let\u2019s stop playing the race card","volume":"15","author":"Grubbs","year":"2020","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026030322005726900_bib45","doi-asserted-by":"crossref","first-page":"e002912","DOI":"10.1161\/CIRCHEARTFAILURE.115.002912","article-title":"Validation and comparison of seven mortality prediction models for hospitalized patients with acute decompensated heart failure","volume":"9","author":"Lagu","year":"2016","journal-title":"Circ Heart Fail"},{"key":"2026030322005726900_bib46","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1164\/rccm.202010-3809CP","article-title":"Mitigating inequities and saving lives with ICU triage during the COVID-19 pandemic","volume":"203","author":"White","year":"2021","journal-title":"Am J Respir Crit Care Med"},{"key":"2026030322005726900_bib47","article-title":"Racial disparities in COVID-19 testing and outcomes: retrospective cohort study in an integrated health system","author":"Escobar","journal-title":"Ann Intern Med"}],"container-title":["American Journal of Respiratory and Critical Care Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/204\/2\/178\/67012442\/ajrccm_204_2_178.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/204\/2\/178\/67012442\/ajrccm_204_2_178.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T03:01:52Z","timestamp":1772593312000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajrccm\/article\/204\/2\/178\/8492491"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7]]},"references-count":47,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,7,15]]},"published-print":{"date-parts":[[2021,7,15]]}},"URL":"https:\/\/doi.org\/10.1164\/rccm.202012-4383oc","relation":{},"ISSN":["1073-449X","1535-4970"],"issn-type":[{"value":"1073-449X","type":"print"},{"value":"1535-4970","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,7]]},"published":{"date-parts":[[2021,7]]},"assertion":[{"value":"2020-12-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-03-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-07-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}