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    Patent Pending

    Sequential Organ Failure Assessment (SOFA) Score

    Predicts ICU mortality based on lab results and clinical data.
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    INSTRUCTIONS

    Welcome Sepsis-3 readers! We've also added the qSOFA Score with a summary of the new definitions and recommendations.

    Use the worst value in a 24-hour period.

    When to Use
    Pearls/Pitfalls
    Why 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.
    • The Sequential Organ Failure Assessment (SOFA) score is a mortality prediction score that is based on the degree of dysfunction of 6 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.

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

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Management

    Even though it is calculated sequentially based on the worse 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 rules such as the SOFA and APACHE II scores should be measured on all patients admitted to the intensive care unit in order to determine the 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 the success or failure of an intervention in the ICU.

    Formula

    Addition of the selected points; points assigned below:

    Facts & Figures

    See formula table, below:

    Criteria Point Value
    PaO2/FiO2 (mmHg)
    <400 +1
    <300 +2
    <200 and mechanically ventilated +3
    <100 and mechanically ventilated +4
    Platelets (×103/µL)
    <150 +1
    <100 +2
    <50 +3
    <20 +4
    Glasgow Coma Scale
    13–14 +1
    10–12 +2
    6–9 +3
    <6 +4
    Bilirubin (mg/dL) [μmol/L]
    1.2–1.9 [>20-32] +1
    2.0–5.9 [33-101] +2
    6.0–11.9 [102-204] +3
    >12.0 [>204] +4
    Mean Arterial Pressure OR administration of vasopressors required
    No Hypotension 0
    MAP <70 mm/Hg +1
    dop ≤5 or dob (any dose) +2
    dop >5 OR epi ≤0.1 OR nor <= 0.1 +3
    dop >15 OR epi >0.1 OR nor >0.1 +4
    Creatinine (mg/dL) [μmol/L] (or urine output)
    <1.2 [<106] 0
    1.2–1.9 [106-168] +1
    2.0–3.4 [177-301] +2
    3.5–4.9 [309-433] (or < 500 ml/d) +3
    >5.0 [>442] (or <200 ml/d) +4

    Evidence Appraisal

    • This paper describes how the European Society of Intensive Care Medicine selected the SOFA score variables.
    • In this validation study, 1,449 patients were enrolled over a period of one month in forty intensive care units (ICUs) in 16 countries. The SOFA score was found to have a good correlation of organ dysfunction/failure in critically ill patients.
    • This prospective, observational cohort study was performed at a university hospital in Belgium and recruited 352 patients. The SOFA score was again found to be a good indicator of prognosis.

    Literature

    Validation

    Research PaperVincent JL, de Mendonça A, Cantraine F, 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):1793–1800.Research PaperFerreira 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.Research PaperCárdenas-Turanzas M, Ensor J, Wakefield C, Zhang K, Wallace SK, Price KJ, Nates JL. Cross-validation of a Sequential Organ Failure Assessment score-based model to predict mortality in patients with cancer admitted to the intensive care unit. J Crit Care. 2012 Dec;27(6):673-80. doi: 10.1016/j.jcrc.2012.04.018. Epub 2012 Jul 2.
    Dr. Jean-Louis Vincent

    About the Creator

    Jean-Louis Vincent, MD, is a professor of intensive care at the University of Brussels and the head of the Department of Intensive Care at Erasme University Hospital, Brussels. He is an organizer of the International Symposium on Intensive Care and Emergency Medicine. Dr. Vincent researches sepsis, acute circulatory failure (circulatory shock) and its treatment, oxygen transport, haemodynamic monitoring, vital emergencies and ethical aspects of intensive care.

    To view Dr. Jean-Louis Vincent's publications, visit PubMed

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