Patient-level reclassification and discordance between Sequential Organ Failure Assessment (SOFA) and SOFA-2: a multicenter ICU study
Authors' conclusion
SOFA-2 introduces systematic reclassification at the patient level. Reciprocal exact-matching analyses demonstrated that patients assigned the same severity by one scoring system remained heterogeneous in mortality according to the other scoring system.
Study context
- Population
- Adult ICU admissions, OneICU Japanese ICU registry (15 hospitals), April 2012–December 2025
- Participants
- 134,528 ICU admissions
- Exposure
- SOFA-2 vs conventional SOFA; dSOFA categories
- Outcome
- Mortality across dSOFA categories after exact matching on Day-1 SOFA-2 and, separately, on conventional SOFA total scores
Methodological detailsmulticentre, exact matching
- Multicentre
- Exact matching
Main finding
As reported in the abstract
Mortality by dSOFA category after exact matching
- Matched on SOFA-2: mortality highest in Negative dSOFA (SOFA higher than SOFA-2)
- Matched on conventional SOFA: mortality highest in Positive dSOFA (SOFA-2 higher than SOFA)
Observational data: associations, not effects.
Further findings
Patient-level reclassification · Day 1
- SOFA-2 resulted in systematic patient-level reclassification
- Upward shifts most frequent in brain, cardiovascular and respiratory subscores; kidney subscore bidirectional
Mortality by subscores
- Mortality increased with higher SOFA-2 subscores at fixed SOFA and with higher SOFA subscores at fixed SOFA-2
Original publication
Patient-level reclassification and discordance between SOFA and SOFA-2: a multicenter ICU study. Crit Care. Published 11 August 2026. doi:10.
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