Development and Validation of the Sequential Organ Failure Assessment (SOFA)-2 Score
Authors' conclusion
The SOFA-2 score, updated to include contemporary organ support treatments and new score thresholds, describes organ dysfunction in a large, geographically and socioeconomically diverse population of critically ill adults.
Study context
- Population
- Adults admitted to 1319 intensive care units (ICUs) in 9 countries, 2014–202310 cohorts
- Comparison
- SOFA-2 vs SOFA-1 score
- Outcome
- Predictive validity (AUROC) of the score measured on the first ICU day
- Follow-up
- First ICU day
Methodological detailsfederated analysis, multicentre, modified Delphi process, internal and external validation, External validation: 6 cohorts, 1 241 114 patients, Development and internal validation: 4 multicentre cohorts, 2 098 356 patients
- Federated analysis
- Multicentre
- Modified Delphi process
- Internal and external validation
- External validation: 6 cohorts, 1 241 114 patients
- Development and internal validation: 4 multicentre cohorts, 2 098 356 patients
Performance
As reported in the abstract
AUROC
SOFA-2
0.79
Area under the receiver operating characteristic (AUROC) · 95% CI 0.76–0.81
SOFA-1
0.77
AUROC · 95% CI 0.74–0.81
Further findings
ICU mortality
- Died in the ICU
- 270 108 (8.1%)
- Range across the 10 cohorts
- 4.5% to 20.5%
Sequential SOFA-2, ICU day 1 to day 7
- Predictive validity maintained
Gastrointestinal and immune dysfunction
- Not incorporated into SOFA-2 (insufficient data, lack of content validity)
Original publication
Development and Validation of the Sequential Organ Failure Assessment (SOFA)-2 Score. JAMA. Published 16 December 2025. doi:10.
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