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Sequential Organ Failure Assessment - Track organ dysfunction severity in ICU
Estimated ICU Mortality:
No organ failure. Continue standard monitoring and care.
SOFA is for tracking organ dysfunction over time. Serial scores more valuable than single measurements. Not designed for individual mortality prediction.
| Organ System | 0 | 1 | 2 | 3 | 4 |
|---|---|---|---|---|---|
| Respiratory (PaO₂/FiO₂) | ≥400 | <400 | <300 | <200 + vent | <100 + vent |
| Coagulation (Platelets ×10³) | ≥150 | <150 | <100 | <50 | <20 |
| Liver (Bilirubin mg/dL) | <1.2 | 1.2-1.9 | 2.0-5.9 | 6.0-11.9 | ≥12.0 |
| Cardiovascular | MAP≥70 | MAP<70 | Dopa≤5 or Dobu any | Dopa>5 or Epi/Norepi≤0.1 | Dopa>15 or Epi/Norepi>0.1 |
| CNS (Glasgow Coma) | 15 | 13-14 | 10-12 | 6-9 | <6 |
| Renal (Creatinine/UO) | <1.2 | 1.2-1.9 | 2.0-3.4 | 3.5-4.9 or UO<500 | ≥5.0 or UO<200 |
Vasopressor doses in μg/kg/min for at least 1 hour. UO = urine output in mL/day.
Calculate daily to track organ dysfunction trends. Increasing scores indicate worsening; decreasing scores suggest improvement. Delta SOFA more predictive than single values.
Increase of ≥2 points from baseline defines organ dysfunction in sepsis. Combined with infection, this meets Sepsis-3 criteria for sepsis diagnosis.
Standardizes severity assessment in critical care research. Widely used endpoint for organ dysfunction studies and intervention trials.
Objective measure of patient trajectory. Helps guide ICU resource allocation, family discussions, and escalation/de-escalation decisions.
SOFA designed for repeated measurements. Single scores less informative than trends. Calculate daily during ICU stay for optimal utility.
Document baseline organ function when possible. Change from baseline more meaningful than absolute score, especially in chronic organ disease.
SOFA describes organ dysfunction, not individual prognosis. Should never be used alone to determine appropriateness of care or end-of-life decisions.
If data unavailable, assume normal (score 0) unless clinical evidence suggests dysfunction. Document missing variables for accurate interpretation.
SOFA (Sequential Organ Failure Assessment) quantifies organ dysfunction across six systems: respiratory, coagulation, liver, cardiovascular, CNS, and renal. Each system scores 0-4 points, with total ranging from 0-24. It's calculated daily in ICU patients to track organ dysfunction trends. Increasing scores indicate worsening condition; decreasing scores suggest improvement. SOFA is integral to Sepsis-3 definitions.
In Sepsis-3 criteria, sepsis is defined as life-threatening organ dysfunction caused by dysregulated host response to infection. Organ dysfunction is operationalized as an acute increase of ≥2 SOFA points from baseline. This replaced older SIRS criteria. SOFA provides objective, quantifiable measure of organ dysfunction that defines sepsis severity.
qSOFA (quick SOFA) is a simplified bedside tool for sepsis screening outside the ICU, using only 3 criteria: altered mental status, respiratory rate ≥22, and systolic BP ≤100. SOFA is more comprehensive with 6 organ systems and requires laboratory values. qSOFA identifies high-risk patients; SOFA quantifies organ dysfunction severity in ICU.
SOFA should be calculated daily for ICU patients, especially those with sepsis or multi-organ dysfunction. Serial measurements capture disease trajectory better than isolated values. Calculate at consistent times (e.g., 24-hour intervals) using worst values from each period. More frequent calculation may be warranted during rapid clinical changes.
SOFA correlates with ICU mortality at population level but should not predict individual outcomes. Higher scores associate with increased mortality risk, but individual patients may defy predictions based on diagnosis, treatment response, and other factors. Use SOFA to track trends and guide discussions, not to determine care appropriateness.
If variables are unavailable, assume normal function (score 0 for that system) unless clinical evidence suggests dysfunction. Document which variables are missing. For cardiovascular system, use available parameters (MAP or vasopressors). Some institutions use modified SOFA omitting unavailable components, but this limits score comparability.
Baseline SOFA is the patient's score before acute illness onset. For sepsis diagnosis, it's assumed to be 0 unless chronic organ dysfunction is documented. In patients with chronic disease, baseline may be elevated. Acute change (delta SOFA ≥2) from baseline is more clinically meaningful than absolute score.
SOFA was developed in 1994 by the European Society of Intensive Care and Emergency Medicine. Originally called Sepsis-related Organ Failure Assessment, it was renamed Sequential to emphasize its utility for serial measurements. It has become the standard for quantifying organ dysfunction worldwide.
SOFA evaluates respiratory (oxygenation), coagulation (platelets), liver (bilirubin), cardiovascular (MAP and vasopressors), CNS (Glasgow Coma Scale), and renal (creatinine/urine output) systems. Each scored 0-4 based on severity of dysfunction. Total score reflects multi-organ dysfunction severity.
Use SOFA alongside clinical assessment, microbiologic data, and imaging. Track trends over ICU stay. Rising scores warrant escalation; falling scores indicate treatment success. Combine with other tools like APACHE II for comprehensive critical illness assessment.
This SOFA score calculator is for educational and informational purposes only. It should not replace clinical judgment or be used alone for care decisions. SOFA describes organ dysfunction but does not predict individual outcomes. Always integrate with comprehensive patient assessment and consult qualified healthcare providers.