SOFA Calculator

Sequential Organ Failure Assessment (SOFA) severity of illness score for hospital mortality

Use the worst value for each physiological variable within the past 24 hours.
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About This Calculator

The Sequential Organ Failure Assessment (SOFA) is a morbidity severity score and mortality estimation tool developed from a large sample of ICU patients throughout the world. Unlike other scoring systems, such as the SAPS II and APACHE II systems, the SOFA was designed to focus on organ dysfunction and morbidity, with less of an emphasis on mortality prediction. The authors designed the system with an emphasis on bedside applicability and simplicity using widely available variables.

Sample Inclusion and Exclusion

The study enrolled 1,449 patients from 40 intensive care units throughout the world during May 1995. The study excluded all patients < 13 years of age or were admitted for less than 48 hours for observation following an uncomplicated surgery.

Study Variables

The SOFA score is made of 6 variables, each representing an organ system. Each organ system is assigned a point value from 0 (normal) to 4 (high degree of dysfunction/failure) The worst physiological variables were collected serially every 24 hours of a patient's ICU admission. The "worst" measurement was defined as the measure that correlated to the highest number of points. The SOFA score ranges from 0 to 24.

Correlation of Total Score and Hospital Mortality

Unlike other ICU mortality systems, SOFA was not designed to accurately predict mortality, and was originally developed examining ICU mortality (not hospital mortality). While there is no direct conversion of SOFA score to mortality, a rough estimate of mortality risk may be made based on two prospective papers that have been published.1,2 Note that this estimation is based on the maximum (highest) SOFA score during a patient's ICU stay.

Maximum
SOFA Score
Mortality
0 to 6 < 10%
7 to 9 15 - 20%
10 to 12 40 - 50%
13 to 14 50 - 60%
15 > 80%
15 to 24 > 90%
Above: Hospital mortality rate associated with maximum SOFA score. The mortality rate was nearly 90% in patients with a SOFA score of more than 15.1

Serial Measurements

Because SAPS II and APACHE II have only been validated in the first 24 hours of ICU admission, it is unknown how well each system predicts mortality following the first day of admission. In a 2001 Belgian study,2 serial SOFA scores were collected during the first 96 hours of admission. In this study, an increasing or unchanged SOFA score in the first 48-96 hours was associated with a higher mortality rate than patients with a decreasing score.

Score Trend
(first 48 hrs)
Mortality
Increasing > 50%
Unchanged 27 - 35%
Decreasing < 27%

References and Additional Reading

  1. Vincent 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):1793-800. PMID 9824069.
  2. Ferreira FL, Bota DP, Bross A, et al. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001;286(14):1754-8. PMID 11594901.

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