Validation of the updated sequential organ failure assessment (SOFA)-2 score in emergency department septic shock

doi:10.1186/s40560-026-00921-3

Sepsis & infection

Validation of the updated sequential organ failure assessment (SOFA)-2 score in emergency department septic shock

J Intensive CarePublished 27 Jul 2026Observational validation study of two prospective registries

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Authors' conclusion

Among ED patients with septic shock, SOFA-2 showed modestly improved discrimination, closer agreement between predicted and observed in-hospital mortality with lower overall prediction error, and more favorable continuous reclassification metrics compared with SOFA-1.

Study context

Population: Adult emergency department (ED) patients with septic shockCohort A 2669

Comparison: SOFA-2 vs Sequential Organ Failure Assessment (SOFA-1) score
Outcome: Discrimination (AUROC) for in-hospital, 28-day and 90-day mortality

Methodological detailstwo prospective septic shock registries, external validation

Two prospective septic shock registries
External validation

Performance

As reported in the abstract

AUROC for mortality

Test or model	AUROC in-hospital mortality, Cohort A	AUROC 28-day mortality, Cohort A	AUROC 90-day mortality, Cohort A	AUROC in-hospital mortality, Cohort B	AUROC 28-day mortality, Cohort B	AUROC 90-day mortality, Cohort B
SOFA-2	0.734	0.719	0.680	0.719	0.737	0.711
SOFA-1	0.702	0.694	0.658	0.671	0.689	0.666

AUROC in-hospital mortality, Cohort A

SOFA-20.734

SOFA-10.702

AUROC 28-day mortality, Cohort A

SOFA-20.719

SOFA-10.694

AUROC 90-day mortality, Cohort A

SOFA-20.680

SOFA-10.658

AUROC in-hospital mortality, Cohort B

SOFA-20.719

SOFA-10.671

AUROC 28-day mortality, Cohort B

SOFA-20.737

SOFA-10.689

AUROC 90-day mortality, Cohort B

SOFA-20.711

SOFA-10.666

SOFA-2 vs SOFA-1: all p < 0.001 — significantly higher for all outcomes in both cohorts

Further findings

Outcome	Estimate	P value
Reclassification (continuous NRI, IDI)SOFA-2 vs SOFA-1 · across all mortality outcomes	continuous NRI 0.276-0.635	all p < 0.001
Reclassification (continuous NRI, IDI)SOFA-2 vs SOFA-1 · across all mortality outcomes	IDI 0.024-0.062	all p < 0.001

Calibration for in-hospital mortality (calibration curve, Brier score)

SOFA-2 generally closer agreement between predicted and observed in-hospital mortality and lower Brier scores

Adjusted association of SOFA-2 with mortality

Each 1-point increase in SOFA-2 independently associated with higher mortality

Score distributions and mortality across score ranges

SOFA-1 and SOFA-2 distributions differed significantly; mortality generally increased with higher scores

Sensitivity and pooled analyses

Consistent findings

Original publication

Validation of the updated sequential organ failure assessment (SOFA)-2 score in emergency department septic shock. J Intensive Care. Published 27 July 2026. doi:10.1186/s40560-026-00921-3

Read the original article ↗

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