Exam

Sequential Organ Failure Assessment Score

search

Sequential Organ Failure Assessment Score, SOFA Score

  • See Also
  1. Systemic Inflammatory Response Syndrome (SIRS)
  2. Sepsis in Adults
  3. qSOFA Score
  4. Pediatric Sequential Organ Failure Score (pSOFA Score)
  • 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
  • Precautions
  1. SOFA Score should not be used to drive or assess specific Sepsis management
  • 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
  • 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
  • Resources
  1. ClinCalc: SOFA Calculator
    1. http://clincalc.com/icumortality/sofa.aspx
  • 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]