SOFA 2 Score

Acute dysfunction of vital organs is the hallmark of critical illness. The SOFA score, most widely used to describe organ dysfunction has not been updated in 30 years during which the treatment of organ dysfunction in critically ill has advanced.

Why we need SOFA 2 ?

•  The SOFA score validated since 1996 describes 6 organ system - Neurological,Cardiovascular, Hepatic, Respiratory, Renal and Coagulation using clinical and biochemical variables.  SOFA score failed to capture the contemporary intervention like drugs and devices that provide support for failing organs.

What is SOFA 2 ?

• SOFA 2 was developed and validated in 10 international multicenter cohort of 3.3 million adult ICU patients. The SOFA -2 Score includes 6 organ system with a total score of 0 - 24. The updated score incorporates commonly used drugs and mechanical organ supports used at present era.
• SOFA 2 score considered inclusion of immune and GI systems but later avoided due to inability of candidate variables to satisfy both content and predictive validity
• The  total score ranges from 0-24 . Higher the score indicates worse organ dysfunction.

SOFA 1 V/s SOFA 2

• Development and validation SOFA 2 Score (JAMA.2025) found that SOFA 2 is better in describing organ dysfunction and mortality.
• The predictive validity of SOFA2 and SOFA1 for ICU mortality was similar (SOFA2 AUROC 0.79;95%CI V/s SOFA 1 AUROC 0.77,95%CI). 
• The study also found that median SOFA 2 score among patients expired at ICU was 9.

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Reference 

• Ranzani OT, Singer M, Salluh JIF, Shankar-Hari M, Pilcher D, Berger-Estilita J, Coopersmith CM, Juffermans NP, Laffey J, Reinikainen M, Neto AS, Tavares M, Timsit JF, Arias Lopez MDP, Arulkumaran N, Aryal D, Azoulay E, Celi LA, Chaudhuri D, De Lange D, De Waele J, Dos Santos CC, Du B, Einav S, Engelbrecht T, Fazla F, Ferrer R, Finazzi S, Fujii T, Gershengorn HB, Greene JD, Haniffa R, Hao S, Hasan MS, Hollenberg S, Ippolito M, Jung C, Kirov M, Kobari S, Lakbar I, Lipman J, Liu V, Liu X, Lobo SM, Magatti D, Martin GS, Metnitz B, Metnitz P, Myatra SN, Oczkowski S, Paiva JA, Paruk F, Pekkarinen PT, Piquilloud L, Pölkki A, Prescott HC, Blaser AR, Rezende E, Robba C, Rochwerg B, Ruckly S, Samei R, Schenck EJ, Secombe P, Sendagire C, Siaw-Frimpong M, Simpkin AJ, Soares M, Summers C, Szczeklik W, Takala J, Tanaka S, Tricella G, Vincent JL, Wendon J, Zampieri FG, Rhodes A, Moreno R. Development and Validation of the Sequential Organ Failure Assessment (SOFA)-2 Score. JAMA. 2025 Dec 16;334(23):2090-2103. doi: 10.1001/jama.2025.20516. PMID: 41159833; PMCID: PMC12573119.