The new Sequential Organ Failure Assessment (SOFA) for sepsis identification and mortality prediction: a multicenter cohort study
Authors' conclusion
The updated SOFA-2 score may identify a moderately larger sepsis population with more advanced organ dysfunction and may provide modestly improved mortality risk stratification compared with SOFA-1, while maintaining substantial diagnostic agreement.
Study context
- Population
- Critically ill adults in ICU, three tertiary hospitals in China (January 2022-October 2025); external validation in MIMIC-IV
- Participants
- 11,669 ICU admissions
- Exposure
- SOFA-2 vs SOFA-1 for Sepsis-3 sepsis identification
- Outcome
- Diagnostic yield and prognostic performance (discrimination for ICU mortality) for sepsis identification
Methodological detailsmulticentre, external validation (MIMIC-IV)
- Multicentre
- External validation (MIMIC-IV)
Main finding
As reported in the abstract
Sepsis identified
P < 0.001
- Diagnostic agreement with SOFA-1 (kappa)
- 0.891-0.908
Observational data: associations, not effects.
Further findings
| Outcome | SOFA-2 | SOFA-1 |
|---|---|---|
| Discrimination for ICU mortality (AUC) | ||
| Internal AUC | 0.720 | 0.703 |
| External AUC | 0.735 | 0.722 |
- Discrimination for ICU mortality (AUC) — Clearer mortality gradients with SOFA-2 in moderate-to-severe dysfunction categories
- P < 0.001
ICU and hospital LOS and mortality, sepsis-SOFA-1 vs sepsis-SOFA-2
- Did not differ significantly (all P > 0.05)
Total scores and organ dysfunction
- SOFA-2 assigned higher total scores in the mid-to-high range and captured more organ dysfunction
Original publication
The new SOFA for sepsis identification and mortality prediction: a multicenter cohort study. J Intensive Care. Published 26 May 2026. doi:10.
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