The Sequential Organ Failure Assessment (SOFA) Score

The SOFA system was created in a consensus meeting of the European Society of Intensive Care Medicine in 1994 and further revised in 1996. The SOFA is a six-organ dysfunction/failure score measuring multiple organ failure daily. Each organ is graded from 0 (normal) to 4 (the most abnormal), providing a daily score of 0 to 24 points. The objective in the development of the SOFA was to create a simple, reliable, and continuous score easily obtained in every institution.

Sequential assessment of organ dysfunction during the first few days of ICU admission is a good indicator of prognosis. Both the mean and highest SOFA scores are particularly useful predictors of outcome. Independent of the initial score, an increase in SOFA score during the first 48 hours in the ICU predicts a mortality rate of at least 50%.

SOFA score
0 1 2 3
4
Respirationa
PaO2/FIO2 (mm Hg)
SaO2/FIO2
>400 <400
221–301
<300
142–220
<200
67–141
<100
<67
Coagulation
Platelets 103/mm3
>150 <150 <100 <50 <20
Liver
Bilirubin (mg/dL)
<1.2 1.2–1.9 2.0–5.9 6.0–11.9 >12.0
Cardiovascularb
Hypotension
No hypotension MAP <70 Dopamine </=5 or
dobutamine (any)
Dopamine >5 or
norepinephrine
</=0.1
Dopamine >15 or
norepinephrine
>0.1
CNS
Glasgow Coma Score
15 13–14 10–12 6–9 <6
Renal
Creatinine (mg/dL)
or urine output
(mL/d)
<1.2 1.2–1.9 2.0–3.4 3.5–4.9 or <500 >5.0 or <200

MAP, mean arterial pressure; CNS, central nervous system; SaO2, peripheral arterial oxygen
saturation.
aPaO2/FIO2 ratio was used preferentially. If not available, the SaO2/FIO2 ratio was used; bvasoactive
mediations administered for at least 1 hr (dopamine and norepinephrine ug/kg/min).

 

 

References:

  1. Jones AE, Trzeciak S, Kline JA. The Sequential Organ Failure Assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation. Crit Care Med. 2009 May;37(5):1649-54. [Medline]
  2. Ferreira FL, Bota DP, Bross A, Mélot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001 Oct 10;286(14):1754-8. [Medline]
  3. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG. 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. [Medline]

Created: Nov 5, 2009

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