The SOFA score (Sequential Organ Failure Assessment) is a 0–24 point scoring system used in the ICU to quantify the degree of dysfunction in six organ systems and to help estimate mortality risk in critically ill patients, especially those with sepsis.
ThemSOFA score was developed to describe and follow organ dysfunction over time rather than to make individual-level triage decisions, though it is often used to support both.
An increase in SOFA of ≥2 points due to infection defines organ dysfunction in Sepsis‑3 and is associated with roughly ≥10% in‑hospital mortality.
SOFA assigns 0–4 points to normal to severe dysfunction in each of six systems, summed for a total score.
Respiratory: PaO₂/FiO₂ ratio, with lower ratios and need for respiratory support scoring higher.
Coagulation: Platelet count, with progressively lower counts scoring higher.
Liver: Total bilirubin, with increasing levels scoring higher.
Cardiovascular: Hypotension and vasopressor requirements (MAP <70, doses of dopamine/dobutamine/epinephrine/norepinephrine).
Central nervous system: Glasgow Coma Scale; lower GCS scores yield higher SOFA points.
Renal: Serum creatinine and/or urine output; higher creatinine or oliguria/anuria score higher.
Total SOFA ranges 0–24; higher scores correlate with higher mortality.
Worsening or rising SOFA over the first 48–96 hours predicts very high mortality, while decreasing SOFA is associated with better outcomes.
Scores >11 correlate with >90% mortality in certain ICU cohorts, but recommend using SOFA only as one input among many.
qSOFA is a bedside prompt for suspected infection outside the ICU, using 3 criteria: RR ≥22, altered mentation (GCS ≤14), and SBP ≤100 mmHg.
A qSOFA ≥2 flags patients at higher risk of death or prolonged ICU stay and should prompt evaluation, often including a full SOFA calculation.
The SOFA-2 (Sequential Organ Failure Assessment 2) score is an updated version of the original SOFA score used to assess organ dysfunction in critically ill patients, particularly those with sepsis.
The SOFA-2 score evaluates six organ systems:
Respiratory- PaO2/FiO2 ratio or SpO2/FiO2 ratio Coagulation- Platelets Liver- Bilirubin Cardiovascular- Mean arterial pressure and vasopressor requirements Central Nervous System- Glasgow Coma Scale Renal- Creatinine or urine output
Each system is scored from 0 (normal) to 4 (most abnormal), with a maximum total score of 24.
The main updates in SOFA-2 compared to the original SOFA include:
Simplified respiratory assessment- Can use SpO2/FiO2 ratio when arterial blood gas isn’t available
SOFA-2 is used to:
Track organ dysfunction over time in sepsis patients Predict mortality risk Define sepsis criteria (baseline SOFA score increase of ≥2 points) Guide clinical decision-making in critical care