Sequential Organ Failure Assessment Score

Aka: Sequential Organ Failure Assessment Score, SOFA Score

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II. Indications

  1. Sepsis diagnosis and severity evaluation in adults
    1. qSOFA Score is typically used instead
    2. Recommended to replace SIRS Criteria in 2016 Sepsis-3 Guidelines
  2. Sepsis prognosis (esp. in-hospital mortality)
    1. Calculate score on ICU admission and then every 48 hours

III. Precautions

  1. SOFA Score should not be used to drive or assess specific Sepsis management

IV. Criteria (based on worst available values in last 24 hours)

  1. Respiratory Function (using SpO2/FIO2 from Pulse Oximetry, or PaO2/FIO2 from ABG)
    1. Score 0: SpO2/FIO2 >302 (or PaO2/FIO2 >400)
    2. Score 1: SpO2/FIO2 <302 (or PaO2/FIO2 <400)
    3. Score 2: SpO2/FIO2 <221 (or PaO2/FIO2 <300)
    4. Score 3: SpO2/FIO2 <142 (or PaO2/FIO2 <200)
    5. Score 4: SpO2/FIO2 <67 (or PaO2/FIO2 <100)
  2. Cardiovascular Function (using mean arterial pressure and Vasopressors)
    1. Score 0: Mean Arterial Pressure (MAP) >=70 mmHg
    2. Score 1: Mean Arterial Pressure (MAP) <70 mmHg
    3. Score 2: Dopamine <=5, OR any Dobutamine
    4. Score 3: Dopamine >5 OR Norepinephrine <=0.1 OR Phenylephrine <=0.8
    5. Score 4: Dopamine >15 OR Norepinephrine >0.1 OR Phenylephrine >0.8 OR any Vasopressin
  3. Hepatic Function (using serum Total Bilirubin)
    1. Score 0: Serum Bilirubin <1.2 mg/dl
    2. Score 1: Serum Bilirubin 1.2 to 1.9 mg/dl
    3. Score 2: Serum Bilirubin 2.0 to 5.9 mg/dl
    4. Score 3: Serum Bilirubin 6.0 to 11.9 mg/dl
    5. Score 4: Serum Bilirubin >12 mg/dl
  4. Renal Function (using Serum Creatinine)
    1. Score 0: Serum Creatinine <1.2 mg/dl
    2. Score 1: Serum Creatinine 1.2 to 1.9 mg/dl
    3. Score 2: Serum Creatinine 2.0 to 3.4 mg/dl
    4. Score 3: Serum Creatinine 3.5 to 4.9 mg/dl
    5. Score 4: Serum Creatinine >5.0 mg/dl
  5. Coagulation Function (using Platelet Count)
    1. Score 0: Platelet Count >= 150 x10^3/mm3
    2. Score 1: Platelet Count < 150 x10^3/mm3
    3. Score 2: Platelet Count < 100 x10^3/mm3
    4. Score 3: Platelet Count < 50 x10^3/mm3
    5. Score 4: Platelet Count < 20 x10^3/mm3
  6. Neurologic Function (using Glasgow Coma Scale)
    1. Score 0: Glasgow Coma Scale (GCS) 15
    2. Score 1: Glasgow Coma Scale (GCS) 13 to 14
    3. Score 2: Glasgow Coma Scale (GCS) 10 to 12
    4. Score 3: Glasgow Coma Scale (GCS) 6 to 9
    5. Score 4: Glasgow Coma Scale (GCS) <6

V. Interpretation: Total SOFA Score 0 to 24

  1. Sepsis criteria (in addition to current infection)
    1. SOFA Score >=2 (or change in SOFA Score by 2 or more points)
    2. Two point increase is associated with a mortality increase as much as 20%
  2. Mortality (based on maximal SOFA Score)
    1. Mortality <10%: SOFA Score 0 to 6
    2. Mortality 15-20%: SOFA Score 7 to 9
    3. Mortality 40-50%: SOFA Score 10 to 12
    4. Mortality 50-60%: SOFA Score 13 to 14
    5. Mortality >80%: SOFA Score 15
    6. Mortality >90%: SOFA Score 15 to 24

VI. Resources

  1. ClinCalc: SOFA Calculator
    1. http://clincalc.com/icumortality/sofa.aspx

VII. References

  1. Guirgis and Khadpe (2017) Crit Dec Emerg Med 31(12): 3-8
  2. Ferreira (2001) JAMA 286(14): 1754-8 +PMID: 11594901 [PubMed]
  3. Vincent (1996) Intensive Care Med 22:707-10 [PubMed]
  4. Vincent (1998) Crit Care Med 26(11):1793-800 +PMID: 9823069 [PubMed]

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