Sequential Organ Failure Assessment (SOFA) Score

Why Use

The SOFA Score can be used to determine level of organ dysfunction and mortality risk in ICU patients.

When to Use

The SOFA Score can be used on all patients admitted to an intensive care unit. It is not clear if the score can be reliably used in patients that were transferred from another ICU.

Formula

Pearls / Pitfalls

The Sequential Organ Failure Assessment (SOFA) Score is a mortality prediction score that is based on the degree of dysfunction of six organ systems. The score is calculated on admission and every 24 hours until discharge using the worst parameters measured during the prior 24 hours. The scores can be used in a number of ways: As individual scores for each organ to determine progression of organ dysfunction. As the sum of scores on one single ICU day. As the sum of the worst scores during the ICU stay. It is believed to provide a better stratification of the mortality risk in ICU patients given that the data used to calculate the score is not restricted to admission values. Tips from creator Dr. Jean-Louis Vincent: The respiratory dysfunction component is often misunderstood. The patient needs to have some respiratory support (mechanical ventilation or CPAP) to have a respiratory score of 3 or 4 (to make sure it is not just some minor atelectasis), but not the other way around: a comatose patient may need mechanical ventilation and yet have no significant hypoxemia. It is also important to realize that the neurological score in sedated/anesthetized patients corresponds with the GCS that the patient would have in the absence of medications (i.e., assumed GCS).

Management

Even though it is calculated sequentially based on the worst values in the past 24 hours, the SOFA Score is not meant to indicate the success or failure of interventions or to influence medical management.

Critical Actions

Clinical prediction tools such as the SOFA and APACHE II Scores can be measured on all patients admitted to the intensive care unit in order to determine level of acuity and mortality risk. This information can then be used in a number of ways, such as to provide the family with a prognosis, for clinical trials, or for quality assessment. The SOFA Score is not designed to influence medical management. As such, it should not be used dynamically or to determine success or failure of an intervention in the ICU.

More Information

Interpretation: SOFA Score Mortality if initial score Mortality if highest score 0-1 0.0% 0.0% 2-3 6.4% 1.5% 4-5 20.2% 6.7% 6-7 21.5% 18.2% 8-9 33.3% 26.3% 10-11 50.0% 45.8% 12-14 95.2% 80.0% >14 95.2% 89.7% Mean SOFA Score Mortality 0-1.0 1.2% 1.1-2.0 5.4% 2.1-3.0 20.0% 3.1-4.0 36.1% 4.1-5.0 73.1% >5.1 84.4% From Ferreira 2001 .