At the 2016 Society of Critical Care Medicine Annual Meeting in Orlando, the SOFA score was presented for the first time, focusing on organ failure. Sepsis is now defined as “life-threatening organ dysfunction due to a dysregulated body response to infection.” The SIRS criteria (from 1992, 2001) on the body’s systemic inflammatory response have been deleted.
SOFA score (for: “Sequential (Sepsis-Related) Organ Failure Assessment Score”) [1. 2]
The SOFA score (SOFA index) is used to track patient status during ICU stay. It is easy to collect and allows the degree of dysfunction of individual organ systems to be reassessed on a daily basis. Points ranging from 0 (normal function) to 4 (significantly impaired function or use of an organ replacement procedure) are assigned for each individual organ system based on organ-specific function or laboratory parameters. Both the mean and the highest SOFA score are predictors of outcome. The SOFA score allows prediction of lethality (mortality relative to the total number of people with the disease): thus, a correlation was shown between increased values of the SOFA score and increased lethality (mean score 0 → lethality 0%, 1 → 3.6%, 2 → 22.5%, 3 → 86.7%; r = 0.445; p = 0.01). Note: The score tables below only award points when conditions are met. In cases where physiological parameters do not meet any of the conditions, zero points are given. In cases where the physiological parameters fit in more than one row, the row with the most points is used as a guide.
| SOFA score | 1 | 2 | 3 | 4 |
| RespirationPaO2/FiO2 (mmHg) | < 400 | < 300 | < 200 and mechanical ventilation | < 100 and mechanical ventilation |
| Nervous SystemGlasgow Coma Scale (GCS). | 13-14 | 10-12 | 6-9 | < 6 |
| Cardiovascular systemMedian arterial pressure (MAD) OR vasopressor administration* required. | MAD <70 mm/Hg | Dopamine ≤ 5 orDobutamine (any dose). | Dopamine > 5 or epinephrine ≤ 0.1 or norepinephrine ≤ 0.1 | Dopamine > 15 or epinephrine > 0.1 or norepinephrine > 0.1 |
| Liver bilirubin (mg/dl) [μmol/l] | 1.2-1.9 [> 20-32] | 2.0-5.9 | 6.0-11.9 | > 12.0 [> 204] |
| CoagulationThrombocytes ×103/µl | < 150 | < 100 | < 50 | < 20 |
| KidneyCreatinine (mg/dl) [μmol/L] (or urine excretion). | 1.2-1.9 | 2.0-3.4 | 3.5-4.9 (or < 500 ml/d) | > 5.0 [> 440] (or < 200 ml/d) |
* Doses of catecholamines in [µg/kg/min].
Legend
- PaO2 = arterial partial pressure of oxygen in mmHg.
- FIO2 = inspiratory O2 concentration; indicates the percentage of oxygen. A FIO2 of 0.3 means 30% O2 by volume in the inspiratory gas.
Glasgow Coma Scale (GCS) – scale for estimating a disorder of consciousness.
| Criterion | Score | |
| Eye opening | spontaneous | 4 |
| on request | 3 | |
| on pain stimulus | 2 | |
| no reaction | 1 | |
| Verbal communication | conversational, oriented | 5 |
| conversational, disoriented (confused) | 4 | |
| incoherent words | 3 | |
| unintelligible sounds | 2 | |
| no verbal reaction | 1 | |
| Motor response | Follows prompts | 6 |
| Targeted pain defense | 5 | |
| untargeted pain defense | 4 | |
| on pain stimulus flexion synergisms | 3 | |
| on pain stimulus stretching synergisms | 2 | |
| No response to pain stimulus | 1 |
Assessment
- Points are awarded for each category separately and then added together. The maximum score is 15, the minimum 3 points.
- If the score is 8 or less, very severe brain dysfunction must be assumed and there is a risk of life-threatening respiratory disorders.
- With a GCS ≤ 8, securing the airway by endotracheal intubation (insertion of a tube (hollow probe) through the mouth or nose between the vocal folds of the larynx into the trachea) must be considered.
Definition of septic shock
| Prerequisites | Adequate fluid substitution |
| Serum lactate (mmol/L (mg/dL)) | ≥ 2 (≥ 18) |
| Mean arterial blood pressure [mmHg] | <65 or use of vasopressors |
Quick SOFA(qSOFA) score
| Respiratory rate [min -1]: | ≥ 22 |
| Awareness | Changed |
| Systolic blood pressure [mmHg] | ≤ 100 |
