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Sequential organ failure assessment (SOFA) score-2 in adults

 

Input
 

Brain
GCS before sedation	Unknown (0) GCS = 15 (0) GCS 13 to 14 (1) CGS 9 to 12 (2) GCS 6 to 8 (3) GCS 3 to 5 (4)
Drug treatment for delirium	No   Yes
Responsiveness points	Thumbs up, fist, or peace sign (0) Localizing to pain (1) Withdrawal to pain (2) Flexion to pain (3) Extension to pain, no response to pain, or general myoclonus (4)
Respiratory
PaO2		kPa mmHg
FIO2		%
Advanced ventilatory support*	No   Yes
ECMO for respiratory support¶	No   Yes
Liver
Total bilirubin		mcmol/L mg/dL
Hemostasis
Platelets		x10^3/microL x10^9/L
Cardiovascular
MAP		mmHg
Vasopressor available	No   Yes
Vasopressor used	No   Yes
Dopamine dose		mcg/kg/min
Norepinephrine doseΔ		mcg/kg/min
Epinephrine dose		mcg/kg/min
Any other vasopressor or inotrope used	No   Yes
Mechanical cardiovascular support◊	No   Yes
ECMO	No   Yes
Other device	No   Yes
Kidney
Creatinine		mg/dL mcmol/L
KRT§	No   Yes
Urine output points	≥0.5 mL/kg/hour (0) <0.5 mL/kg/hour for 6 to 12 hours (1) <0.5 mL/kg/hour for ≥12 hours (2) <0.3 mL/kg/hour for ≥24 hours (3) Anuria for ≥12 hours (3)

 

Results
 
Important: Inputs must be complete to perform calculation.

 

PaO2 to FIO2 ratio		kPa mmHg
Brain points
Respiratory points
Liver points
Hemostasis points
Cardiovascular points
Kidney points
SOFA-2 score

 

SOFA-2 score interpretation

 

0 to 7 points:	<20% ICU mortality risk
8 to 11 points:	20 to <40% ICU mortality risk
12 to 14 points:	40 to <60% ICU mortality risk
15 to 19 points:	60 to <80% ICU mortality risk
20 to 24 points:	>80% ICU mortality risk

 

 

Data action

 

     
 
Include literature references: Yes   No

 

 

 

Notes

• In this calculator, mcg is the abbreviation for micrograms.
• SOFA-2 is an updated version of the original SOFA score. It contains all the original organ domains but is now validated in all-comer ICU patients and has a detailed revision of the definitions of and thresholds for organ support.
• ECMO: extracorporeal membrane oxygenation; GCS: Glasgow Coma Scale; IABP: intra-aortic balloon pump; ICU: intensive care unit; KRT: kidney replacement therapy; LVAD: left ventricular assist device; MAP: mean arterial pressure; PaO₂/FiO₂: ratio of partial pressure of oxygen to fraction of inspired oxygen; SOFA: Sequential Organ Failure Assessment.
• * Advanced ventilatory support is defined as receiving high-flow nasal cannula, continuous positive airflow pressure, bilevel positive airway pressure, noninvasive ventilation, invasive mechanical ventilation, or long-term home ventilation.
• ¶ If used for respiratory failure, ECMO (all forms) should be scored 4 points in the respiratory component (regardless of PaO₂/FIO₂ ratio) but not in the cardiovascular component. If used for cardiovascular indications (all forms), it should be automatically scored in both the cardiovascular and the respiratory systems.
• Δ Norepinephrine is usually dispensed as the salt (eg, hemitartrate or bitartrate). Dose should be expressed as the base. 1 mg of norepinephrine base is equivalent to 2 mg of norepinephrine bitartrate monohydrate, 1.89 mg of the anhydrous bitartrate (also called hydrogen tartrate, acid tartrate, or tartrate), and 1.22 mg of the hydrochloride.
• ◊ Mechanical cardiovascular support may include venoarterial ECMO, IABP, LVAD, or a microaxial flow pump, among others.
• § Excludes patients receiving KRT exclusively for nonrenal causes (eg, removal of toxic products, bacterial toxins, cytokines).

 
Equations used
 

PaO2 to FIO2 ratio = 100 * PaO2 / FIO2

SOFA-2 score = Brainpoints + Respiratorypoints + Liverpoints + Hemostasispoints + Cardiovascularpoints + Kidneypoints

 

 

Calculation Details and Variables

• When there is Drug treatment for delirium GCSPoints is assigned 1 point, even if GCS is 15.
• BrainPoints is assigned the higher of the GCSPoints and the ResponsivenessPoints (shown above) value.
• Equation parameters such as Responsiveness points, have two or more discrete values that may be used in the calculation. The numbers in the parentheses, e.g. (0), represent the values that will be used.
• RespiratoryPoints are assigned values by this ordered logic:
  • If PaO₂/FIO₂ ≤75 mmHg (≤10 kPa) with Advanced ventilatory support or ECMO, RespiratoryPoints = 4
  • Else if PaO₂/FIO₂ ≤150 mmHg (≤20 kPa) with Advanced ventilatory support, RespiratoryPoints = 3
  • Else if PaO₂/FIO₂ ≤225 mmHg (≤30 kPa), RespiratoryPoints = 2
  • Else if PaO₂/FIO₂ ≤300 mmHg (≤40 kPa), RespiratoryPoints = 1
  • Else RespiratoryPoints = 0.
• LiverPoints is assigned values by this ordered logic:
  • If Total bilirubin ≤1.2 mg/dL (≤20.6 mcmol/L), LiverPoints = 0
  • Else if Total bilirubin ≤3 mg/dL (≤51.3 mcmol/L), LiverPoints = 1
  • Else if Total bilirubin ≤6 mg/dL (≤102.6 mcmol/L), LiverPoints = 2
  • Else if Total bilirubin ≤12 mg/dL (≤205 mcmol/L), LiverPoints = 3
  • Else LiverPoints = 4.
• HemostasisPoints is assigned values by this ordered logic:
  • If Platelets ≤50 x10^3/microL (≤50x10^9/L), HemostasisPoints = 4
  • Else if Platelets ≤80 x10^3/microL (≤80x10^9/L), HemostasisPoints = 3
  • Else if Platelets ≤100 x10^3/microL (≤100x10^9/L), HemostasisPoints = 2
  • Else if Platelets ≤150 x10^3/microL (≤150x10^9/L), HemostasisPoints = 1
  • Else HemostasisPoints = 0.
• MAPPoints is assigned values by this ordered logic:
  • If MAP <40 mmHg, MAPPoints = 4
  • Else if MAP <50 mmHg, MAPPoints = 3
  • Else if MAP <60 mmHg, MAPPoints = 2
  • Else if MAP <70 mmHg, MAPPoints = 1
  • Else MAPPoints = 0.
• If vasoactive drugs are unavailable CardiovascularPoints = MAPPoints.
• If vasoactive drugs are available but not used, CardiovascularPoints = 1 for MAP <70mmHg, or 0 for MAP ≥70 mmHg.
• If vasoactive drugs are available and used, CardiovascularPoints is based on the type and dose given. For additional details on CardiovascularPoints scoring, refer to Moreno.^[2]
• CreatininePoints is assigned values by this ordered logic:
  • If Creatinine >3.5 mg/dL (>300 mcmol/L), CreatininePoints = 3
  • Else if Creatinine >2 mg/dL (>170 mcmol/L), CreatininePoints = 2
  • Else if Creatinine >1.2 mg/dL (>110 mcmol/L), CreatininePoints = 1
  • Else CreatininePoints = 0.
• KidneyPoints is assigned values by this ordered logic:
  • If receiving or fulfills criteria for KRT (includes chronic use), KidneyPoints = 4
  • Else if CreatininePoints = 0, KidneyPoints = 0
  • Else KidneyPoints is assigned the higher of the CreatininePoints or UrineOutputPoints (shown above).
• Equation parameters, such as Responsiveness points and Urine output points, have more than one discrete value that may be used in the calculation. The numbers in the parentheses, eg, (0), represent the values that will be used.

 

References

1. Ranzani OT, Singer M, Salluh JIF, et al. Development and Validation of the Sequential Organ Failure Assessment (SOFA)-2 Score. JAMA. 2025;334:2090. PubMed ID: 41159833
2. Moreno R, Rhodes A, Ranzani O, et al. Rationale and Methodological Approach Underlying the Development of the Sequential Organ Failure Assessment (SOFA)-2 Score. JAMA Netw Open. 2025 Oct 1;8. PubMed ID: 41159829

 

Associated Medical Subject Headings [MeSH]
 

80 and over,   Adult,   Aged,   Critical Illness,   Data Science,   Delphi Technique,   Female,   Humans,   Intensive Care Units,   Male,   Middle Aged,   Multiple Organ Failure,   Organ Dysfunction Scores,   ROC Curve

 

Associated Logical Observation Identifiers Names and Codes [LOINC]
 

Parameter	LOINC's and Suggested Units
PaO2	11556-8 : mmHg      2703-7 : mmHg      19254-2 : mmHg
FIO2	3150-0 : %      19993-5 : %      19992-7 : %      19994-3 : %      19996-8 : %      19995-0 : %
Bilirubin	1975-2 : mg/dL      32303-0 : mmol/L      59828-4 : mg/dL      54363-7 : mcmol/L      58941-6 : mg/dL
Platelets	777-3 : x10^9/L      26515-7 : x10(3)/mcL
MAP	8478-0 : mmHg      8458-2 : mmHg      76214-6 : mmHg      75996-9 : mmHg      76536-2 : mmHg
Creatinine	2160-0 : mg/dL      38483-4 : mg/dL      14682-9 : mcmol/L      22726-4 : mcmol/L      59826-8 : mcmol/L

 
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