Sequential (Sepsis Related) Organ Failure Assessment Score (SOFA)

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Background

The SOFA score is a scoring system to determine the extent of a person's organ function or rate of failure.[1][2][3] The score is based on six different scores based on the organ system involved. Use the worst value in a 24-hour period.

Predicting Outcomes

Both the mean and highest SOFA scores being predictors of outcome.

  • An increase in SOFA score during the first 24 - 48 hours in the ICU predicts a mortality rate of at least 50% up to 95%. Scores less than 9 give predictive mortality at 33% while above 11 can be close to or above 95%[4]
  • A SOFA score ≥2 reflects an overall mortality risk of approximately 10% in a general hospital population with suspected infection[5]
  • SOFA (AUROC = 0.74; 95% CI, 0.73-0.76) was superior to that with SIRS (AUROC = 0.64; 95% CI, 0.62-0.66) when used in the ICU
  • SOFA (AUROC = 0.79; 95% CI, 0.78-0.80) or change in SOFA score (AUROC = 0.79; 95% CI, 0.78-0.79) was similar to that with SIRS (AUROC = 0.76; 95% CI, 0.75-0.77) when used outside of the ICU

Scoring

Respiratory System

PaO2/FiO2 (mmHg) SOFA score
< 400 1
< 300 2
< 200 and mechanically ventilated 3
< 100 and mechanically ventilated 4

Nervous System

Glasgow Coma Scale (GCS) SOFA score
13–14 1
10–12 2
6–9 3
< 6 4

Cardio Vascular System

Mean Arterial Pressure OR administration of vasopressors required SOFA score
MAP < 70 mm/Hg 1
Dopamine drip <= 5 or
Dobutamine (any dose)
2
Dopamine >5 or
Epinephrine <=0.1 or
Norepinephrine <=0.1
3
Dopamine >15 or
Epinephrine >0.1 or
Norepinephrine >0.1
4

vasopressor doses are all in µg/kg/min

Liver

Bilirubin (mg/dl) [μmol/L] SOFA score
1.2–1.9 [> 20-32] 1
2.0–5.9 [33-101] 2
6.0–11.9 [102-204] 3
> 12.0 [> 204] 4

Coagulation

Platelets×103/µl SOFA score
< 150 1
< 100 2
< 50 3
< 20 4

Renal System

Creatinine (mg/dl) [μmol/L] (or urine output) SOFA score
1.2–1.9 [110-170] 1
2.0–3.4 [171-299] 2
3.5–4.9 [300-440] (or < 500 ml/d) 3
> 5.0 [> 440] (or < 200 ml/d) 4

See Also

External Links

References

  1. Vincent JL et al. 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. Intensive Care Med 1996 Jul;22(7):707-10. PMID 8844239.
  2. Ferreira FL et al. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 2001 Oct 10;286(14):1754-8. PMID 11594901
  3. de Mendonça A et al. Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med 2000 Jul;26(7):915-21. PMID 10990106
  4. Vincent JL, et al; Working Group on “Sepsis-Related Problems” of the European Society of Intensive Care Medicine. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Crit Care Med. 1998;26(11):1793-1800.
  5. Singer, M et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810.