The Sequential Organ Failure Assessment (SOFA)-2 score was developed to better reflect contemporary critical care practice by incorporating modern organ support modalities and updated thresholds based on recent data. However, the generalizability of this framework to intensive care unit (ICU) populations beyond the development cohort, particularly across organ support subgroups and major disease categories, remains uncertain. We aimed to evaluate the external validity of SOFA-2 using the OneICU database, a large Japanese critical care database with comprehensive domain-level data. Adult ICU stays between February 2013 and August 2025 were included and classified into two cohorts: those with complete SOFA-1 and SOFA-2 component data on the day of ICU admission, and those with complete SOFA-2 data on that day. Discriminatory performance for ICU mortality was evaluated using the area under the receiver operating characteristic curve (AUROC) and compared between SOFA-1 and SOFA-2 using the DeLong test. Subgroup analyses were performed by major organ support device use and across disease categories. Among 152,883 eligible ICU stays, 67,116 had complete SOFA-1 and SOFA-2 data, and 121,443 had complete SOFA-2 data. SOFA-2 showed a slightly higher AUROC for ICU mortality than SOFA-1 (0.859 vs. 0.853; p < 0.001), although the absolute difference was small. Across subgroups defined by mechanical circulatory support use, SOFA-2 showed higher discrimination than SOFA-1. Discrimination was similar in other device-defined subgroups and in patients readmitted to the ICU. SOFA-2 also demonstrated good discrimination across major diagnostic groups. SOFA-2 showed similar discrimination for ICU mortality compared with SOFA-1 and maintained broadly comparable performance across clinically relevant subgroups, supporting its applicability for early severity assessment in heterogeneous ICU populations.
Synchronous renal cell carcinoma (RCC) and colorectal cancer are uncommon, and the optimal surgical strategy remains controversial. We report a patient with synchronous RCC and sigmoid colon cancer successfully treated with a one-stage, robot-assisted combined approach using the da Vinci 5 system. A 60-year-old woman presented with severe anemia. Imaging revealed a left-sided renal tumor, sigmoid colon cancer, and a solitary pulmonary metastasis. Both tumors were considered surgical indications, and early intervention was required due to the risk of bowel obstruction. Robot-assisted radical nephrectomy, followed by robot-assisted sigmoid colectomy, was performed in a single session. The total operative time was 4 h 19 min, with minimal blood loss and no intraoperative complications. Simultaneous robotic resection for synchronous RCC and sigmoid colon cancer is feasible and safe in selected patients when supported by careful preoperative planning and multidisciplinary collaboration.
ABSTRACT Introduction Pheochromocytoma is a rare catecholamine‐secreting tumor that can cause severe cardiovascular complications. Its association with ruptured abdominal aortic aneurysm is extremely rare. Case Presentation A 57‐year‐old man with no significant medical history presented with sudden abdominal pain and hemorrhagic shock. Computed tomography revealed a ruptured infrarenal abdominal aortic aneurysm, and emergency endovascular aneurysm repair was successfully performed. Preoperative imaging incidentally detected a hypervascular left adrenal mass. Although biochemical findings were borderline, 123I‐metaiodobenzylguanidine scintigraphy demonstrated intense uptake, leading to a diagnosis of pheochromocytoma. After appropriate α‐adrenergic blockade, elective laparoscopic adrenalectomy was safely performed, and histopathology confirmed pheochromocytoma. Conclusion This case highlights the importance of considering pheochromocytoma as an underlying cause of ruptured abdominal aortic aneurysm and demonstrates that a staged strategy with emergency endovascular repair followed by definitive endocrine surgery can be safe and effective.
