Sequential Organ Failure Assessment Score

Original Editor - Uchechukwu Chukwuemeka

Top Contributors - Uchechukwu Chukwuemeka and Lucinda hampton  

Introduction[edit | edit source]

Quick sofa score graphic

The sequential organ failure assessment score (SOFA score) is used to monitor a patient's condition while they are in an intensive care unit (ICU) in order to gauge how well their organs are functioning or how quickly they are failing[1][2]. It was first developed to quantify the severity of sickness in sepsis[3]. The SOFA score is used in diverse settings, including medical, trauma, surgical, cardiac, and neurological ICUs.

Although many different scoring systems have been created, the Sequential Organ Failure Assessment (SOFA) score is now the most used in real-world applications[4] [2][5]. It was developed by consensus[2].

Objective[edit | edit source]

It is employed to keep an eye on a patient's condition while in an intensive care unit (ICU) to determine how well or rapidly their organs are failing, as well as evaluate the impact of new therapies on the progression of organ dysfunction/failure. This could be used to characterize patients at entry (and even serve as an entry criterion) or to evaluate treatment effects. The SOFA score does not distinguish between the impacts of acute organ dysfunction associated with critical illness and persistent organ failure occurring owing to underlying disease.[4]

Intended Population[edit | edit source]

The SOFA score is intended for critically ill patients and/or patients in the intensive care unit (ICU) to better understand the natural history of organ dysfunction/failure and the interrelationship between organ failure due to sepsis.

Method of Use[edit | edit source]

Six distinct scores, one for each of the respiratory, cardiovascular, hepatic, coagulation, renal, and neurological systems (central nervous system)make up the final result. Each organ system received a score ranging from 0 (normal) to 4 (most abnormal), with a minimum SOFA score of 0 and a maximum SOFA score of 24[4].

The table below summarizes the scoring of SOFA.

There is also the fast SOFA score (qSOFA), a shortened version of SOFA which aids medical professionals in determining the likelihood of morbidity and mortality as a result of sepsis using four variables as depicted in the table below
Quick SOFA
Is the patient in the ICU? If Yes  
Altered Mentation (GCS) >/=1
Respiratory rate (breaths per minute) >22
Systolic blood pressure (mmHg) <100

The SOFA Score[edit | edit source]

Score Central nervous system

Glasgow Coma Score

Respiratory system

PaO 2/FiO2, mmHg

Cardiovascular system

Mean arterial pressure(mmHg) or Vasopressors administered (μg/kg/min)

Coagulation

Platelets x 103/mm3

Hepatic function

Bilirubin, mg/dl(μmol/L)

Renal function

Creatinine, mg/dl(μmol/L) or Urine output (ml/day)

0 15 </=400 MAP >/=70 >/=150 <1.2 (<20) <1.2 (<110)
1 13-14 <400 MAP <70 <150 1.2- 1.9 (20-32) 1.2- 1.9 (110-170)
2 10-12 <300 Dopamine </=5 or dobutamine (any dose) <100 2.0- 5.9 (33-101) 2.0- 3.4 (171-299)
3 6-9 <200 with ventilatory support Dopamine > 5 or epinephrine </=0.1 or norepinephrine </=0.1 <50 6.0-11.9 (102-204) 3.5-4.9 (300 - 440)

or < 500

4 <6 <100 with ventilatory support Dopamine > 15 or epinephrine > 0.1 or norepinephrine > 0.1 <20 >12.0 (>204) >5.0 ( > 440)

or <200

Evidence[edit | edit source]

Validity[edit | edit source]

The score's utility assessed prospectively in 16 countries [1]found that some sub-scores, as well as the total score, were related to survival. Moreno et al. investigated the impact of the maximum SOFA score in the same population and discovered a strong relationship between increasing score and mortality[8]. The score performed well as a predictor of ICU discharge survival status. Aside from the maximum SOFA score, the change in score, or delta SOFA (total maximum SOFA score minus admission total SOFA score), was found to have a strong correlation with ICU mortality[8][9].

Further evaluations in various settings have validated the SOFA score, its maximum value during an ICU stay, and the change in SOFA over time as valid tools for assessing morbidity in critical illness [10][11][12], and the score has become a common feature of observational study reporting. SOFA score also has a good discriminant validity when compared to Acute Physiology and Chronic Health Evaluation (APACHE) III, Multiple Organ Dysfunction Score, and Logistic Organ Dysfunction score[13]

Reliability[edit | edit source]

The total SOFA score had an intraclass correlation coefficient of 0.889. The weighted kappa values for the central nervous system were moderate (0.552), good (0.634), and nearly perfect (>0.8) for the other organ systems. To assess accuracy, the physicians' scores were compared to a gold standard based on two experts' consensus. In 53% (n = 158) of the cases, the total SOFA score was correct. The absolute deviations of the recorded total SOFA scores from the gold standard total SOFA scores were 0.82 on average. Inattention, calculation errors, and misinterpretation of scoring rules were all common causes of errors[14].

References[edit | edit source]

  1. 1.0 1.1 Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26(11):1793-800. doi: 10.1097/00003246-199811000-00016.
  2. 2.0 2.1 2.2 Soo A, Zuege DJ, Fick GH, Niven DJ, Berthiaume LR, Stelfox HT, et al. Describing organ dysfunction in the intensive care unit: a cohort study of 20,000 patients. Crit Care. 2019;23(1):186. doi: 10.1186/s13054-019-2459-9.
  3. Kashyap R, Sherani KM, Dutt T, Gnanapandithan K, Sagar M, Vallabhajosyula S, Vakil AP, Surani S. Current Utility of Sequential Organ Failure Assessment Score: A Literature Review and Future Directions. The Open Respiratory Medicine Journal. 2021;15:1.Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8227444/ (accessed 31.12.2022)
  4. 4.0 4.1 4.2 Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score describes 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;22(7):707-10. doi: 10.1007/BF01709751.
  5. de Grooth HJ, Geenen IL, Girbes AR, Vincent J-L, Parienti J-J, Oudemans-van Straaten HM. SOFA and mortality endpoints in randomized controlled trials: a systematic review and meta-regression analysis. Crit Care 21, 38 (2017). https://doi.org/10.1186/s13054-017-1609-1
  6. Nursing Station. SOFA SCORE IN ICU... EASY WAY #nursing #nursingeducation #sofascore #intensivecareunit #mortality. Available from: http://www.youtube.com/watch?v=42EZ1dP0DIA [last accessed 29/12/2022]
  7. Ausmed. qSOFA Score (Quick Sepsis-Related Organ Failure Assessment) | Ausmed Explains... Available from: http://www.youtube.com/watch?v=pMfMt1L0oQA[last accessed 29/12/2022]
  8. 8.0 8.1 Moreno R, Vincent JL, Matos R, Mendonca A, Cantraine F, Thijs L, et al. The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Working Group on Sepsis related Problems of the ESICM. Intensive Care Med. 1999;25(7):686–96.
  9. Lambden S, Laterre PF, Levy MM, Francois B. The SOFA score—development, utility and challenges of accurate assessment in clinical trials. Crit Care 23, 374 (2019). https://doi.org/10.1186/s13054-019-2663-7
  10. Ferreira FL, Bota DP, Bross A, Melot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001;286(14):1754–8.
  11. Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006;34(2):344–53
  12. Lie KC, Lau C-Y, Van Vinh Chau N, West TE, Limmathurotsakul D, for Southeast Asia Infectious Disease Clinical Research N. Utility of SOFA score, management and outcomes of sepsis in Southeast Asia: a multinational multicenter prospective observational study. J Intensive Care. 2018;6:9.
  13. Pettila V, Pettila M, Sarna S, Voutilainen P, Takkunen O. Comparison of multiple organ dysfunction scores in the prediction of hospital mortality in the critically ill. Crit Care Med. 2002;30(8):1705–11.
  14. Arts DG, de Keizer NF, Vroom MB, de Jonge E. Reliability and accuracy of Sequential Organ Failure Assessment (SOFA) scoring. Crit Care Med. 2005 Sep;33(9):1988-93. doi: 10.1097/01.ccm.0000178178.02574.ab.

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