SOFA Score
Sequential Organ Failure Assessment for ICU mortality prediction
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Why use it
Tracks organ dysfunction longitudinally in ICU patients. An increase in SOFA ≥ 2 is a key criterion for sepsis diagnosis (Sepsis-3). Predicts ICU mortality and helps guide escalation/de-escalation of care.
About
The Sequential Organ Failure Assessment (SOFA) score quantifies the degree of organ dysfunction across six organ systems: respiratory, coagulation, liver, cardiovascular, CNS, and renal. It is used to track ICU patient status over time. An acute change in SOFA ≥ 2 from baseline is part of the Sepsis-3 definition for sepsis.
When to use
- ICU admission for organ dysfunction assessment
- Suspected sepsis (Sepsis-3 definition: infection + SOFA increase ≥ 2)
- Daily ICU assessment to track clinical trajectory
- Prognostication and family discussions
Formula
Pearls & pitfalls
- SOFA is designed for serial measurement — trends are more informative than single values.
- Baseline SOFA is assumed to be 0 for patients without known pre-existing organ dysfunction.
- qSOFA (≥2 of: RR ≥22, altered mentation, SBP ≤100) is a bedside screening tool, NOT a substitute for SOFA.
- SOFA does not include lactate — consider it separately for septic shock assessment.
- Cardiovascular SOFA component includes vasopressor doses — ensure accurate documentation.
Next steps
SOFA ≥ 2 with suspected infection = sepsis. Increasing SOFA suggests clinical deterioration; consider escalation. Decreasing SOFA suggests improvement. Initial SOFA and maximum SOFA correlate with ICU mortality.
Evidence
Validated in multiple large ICU cohorts. The Sepsis-3 consensus (JAMA 2016) adopted SOFA as the primary organ dysfunction tool for sepsis definition. Initial SOFA >11 associated with >80% ICU mortality in the original study.