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Sequential Organ Failure Assessment (SOFA) Score

Predicts ICU mortality based on lab results and clinical data.

CreatorDr. Jean-Louis Vincent, MD
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Instructions

  • Calculate on admission and then serially, using the most abnormal values for each component over a 24-hour period.

  • May apply in non-ICU settings to assess need for potential ICU admission.

  • Normal range:

    • 75 - 100 mm Hg

    • 10 - 13.3 kPa

Min 0 – Max 700

Introduction

The Sequential Organ Failure Assessment (SOFA) score measures how well six major organ systems are working in critically ill patients, and tracks changes over time. It was developed in 1996 by Jean-Louis Vincent and colleagues for the European Society of Intensive Care Medicine, originally under the name “Sepsis-related Organ Failure Assessment.” It was soon applied to all ICU patients, not just those with sepsis. Today it’s one of the most widely used scores in intensive care, and it’s part of the current international definition of sepsis (Sepsis-3).

What it assesses

Each of six organ systems is scored from 0 (normal) to 4 (most severe dysfunction), using the worst value in each 24-hour period:

System

0

1

2

3

4

Respiration: PaO₂/FiO₂, mmHg

≥400

<400

<300

<200 with respiratory support

<100 with respiratory support

Coagulation: platelets, ×10³/μL

≥150

<150

<100

<50

<20

Liver: bilirubin, mg/dL (μmol/L)

<1.2 (<20)

1.2–1.9 (20–32)

2.0–5.9 (33–101)

6.0–11.9 (102–204)

≥12.0 (>204)

Cardiovascular

MAP ≥70 mmHg

MAP <70 mmHg

Dopamine ≤5 or any dobutamine

Dopamine >5, or epinephrine ≤0.1, or norepinephrine ≤0.1

Dopamine >15, or epinephrine >0.1, or norepinephrine >0.1

Central nervous system: Glasgow Coma Scale

15

13–14

10–12

6–9

<6

Renal: creatinine, mg/dL (μmol/L), or urine output

<1.2 (<110)

1.2–1.9 (110–170)

2.0–3.4 (171–299)

3.5–4.9 (300–440), or urine <500 mL/day

≥5.0 (>440), or urine <200 mL/day

Vasopressor doses are in μg/kg/min, given for at least one hour. “Respiratory support” means mechanical ventilation, including non-invasive ventilation. For sedated patients, the GCS is usually estimated as the patient’s score before sedation.

Scoring & Interpretation

The six organ scores are added for a total from 0 to 24. Higher scores mean more severe organ dysfunction and a higher risk of death.

SOFA Score

Initial Score Mortality

Highest Score Mortality

0-1

0.0%

0.0%

2-3

6.4%

1.5%

4-5

20.2%

6.7%

6-7

21.5%

18.2%

8-9

33.3%

26.3%

10-11

50.0%

45.8%

12-14

95.2%

80.0%

>14

95.2%

89.7%

Mean SOFA Score

Mortality

0-1.0

1.2%

1.1-2.0

5.4%

2.1-3.0

20.0%

3.1-4.0

36.1%

4.1-5.0

73.1%

>5.1

84.4%

Source Ferreira 2001.

Limitations

The original SOFA dates from 1996, so it doesn’t reflect some modern treatments, such as vasopressin and mechanical heart or lung support. That led to the 2025 SOFA-2 update. Scores can be affected by sedation (GCS), chronic conditions such as chronic kidney or liver disease, and treatments like platelet transfusion. SOFA describes organ dysfunction and risk for groups of patients. It isn’t designed to predict an individual patient’s outcome or to guide treatment decisions on its own.

All questions & possible results

SOFA componentsTitle not visible
PaO₂

  • Normal range:

    • 75 - 100 mm Hg

    • 10 - 13.3 kPa

A number between 0 and 700, in mmHg or kPa.

FiO₂

Estimating FiO₂ from oxygen flow/delivery rates:

Type of O₂ delivery

Flow rates, L/min

FiO₂

Nasal cannula

1-6

~4% FiO₂ added above room air* per 1 L/min

  • Room air = 21% 

  • 1 L/min = 25%

  • 2 L/min = 29%

  • 3 L/min = 33%

  • 4 L/min = 37%

  • 5 L/min = 41%

  • 6 L/min = 45%

Simple face mask

~6-12

35-60%*

Non-rebreather mask

10-15

~70-90%

High-flow nasal cannula

Up to 60

30-100%

*Varies based on respiratory rate and minute ventilation.

A number between 21 and 100, in %.

Is the patient mechanically ventilated?

  • Including CPAP

Select one option:

  • No
  • Yes
Platelets

Select one option:

  • ≥150 ×10³/µL
  • 100-149
  • 50-99
  • 20-49 ×10³/µL
  • <20
Bilirubin

Select one option:

  • <1.2 mg/dL (<20 )
  • 1.2–1.9 mg/dL (20–32 µmol/L)
  • 2.0–5.9 mg/dL (33–101 )
  • 6.0–11.9 mg/dL (102–204 )
  • ≥12.0 mg/dL (≥204 µmol/L)
Mean arterial pressure (MAP) or vasoactive agent requirement

  • Listed doses are in units of mcg/kg/min

  • MAP Calculator

Select one option:

  • No hypotension (MAP ≥70 mmHg)
  • MAP <70 mmHg
  • DOPamine ≤5 or DOBUTamine (any dose)
  • DOPamine >5, EPINEPHrine ≤0.1, or norEPINEPHrine ≤0.1
  • DOPamine >15, EPINEPHrine >0.1, or norEPINEPHrine >0.1
Glasgow Coma Scale

Select one option:

  • 15
  • 13–14
  • 10–12
  • 6–9
  • <6
Creatinine or urine output

Select one option:

  • <1.2 mg/dL (<110 µmol/L)
  • 1.2–1.9 mg/dL (110–170 )
  • 2.0–3.4 mg/dL (171–299 )
  • 3.5–4.9 mg/dL (300–440 µmol/L) or urine output <500 mL/day
  • ≥5.0 mg/dL (≥440 µmol/L) or urine output <200 mL/day
Possible results
SOFA Score (0–1 pts): Initial score mortality 0.0%. Highest score mortality 0.0%.

  • Reassess regularly, as the trend over time carries more information than a single value.

  • A rising score over serial assessments indicates worsening organ dysfunction.

  • Source: Ferreira 2001.

SOFA Score (4-5 pts): Initial score mortality 20.2%. Highest score mortality 6.7%.

  • Reassess regularly, as the trend over time carries more information than a single value.

  • A rising score over serial assessments indicates worsening organ dysfunction.

  • Source: Ferreira 2001.

SOFA Score (6-7 pts): Initial score mortality 21.5%. Highest score mortality 18.2%.

  • Reassess regularly, as the trend over time carries more information than a single value.

  • A rising score over serial assessments indicates worsening organ dysfunction.

  • Source: Ferreira 2001.

SOFA Score (8-9 pts): Initial score mortality 33.3%. Highest score mortality 26.3%.

  • Reassess regularly, as the trend over time carries more information than a single value.

  • A rising score over serial assessments indicates worsening organ dysfunction.

  • Source: Ferreira 2001.

SOFA Score (10-11 pts): Initial score mortality 50.0%. Highest score mortality 45.8%.

  • Reassess regularly, as the trend over time carries more information than a single value.

  • A rising score over serial assessments indicates worsening organ dysfunction.

  • Source: Ferreira 2001.

SOFA Score (12-14 pts): Initial score mortality 95.2%. Highest score mortality 80.0%.

  • Reassess regularly, as the trend over time carries more information than a single value.

  • A rising score over serial assessments indicates worsening organ dysfunction.

  • Source: Ferreira 2001.

SOFA Score (>14 pts): Initial score mortality 95.2%. Highest score mortality 89.7%.

  • Reassess regularly, as the trend over time carries more information than a single value.

  • A rising score over serial assessments indicates worsening organ dysfunction.

  • Source: Ferreira 2001.

SOFA Score (2-3 pts): Initial score mortality 6.4%. Highest score mortality 1.5%.

  • Reassess regularly, as the trend over time carries more information than a single value.

  • A rising score over serial assessments indicates worsening organ dysfunction.

  • Source: Ferreira 2001.

Mean SOFA Score (0–1.0): Mortality 1.2%

Mean SOFA Score (1.1–2.0): Mortality 5.4%

Mean SOFA Score (2.1–3.0): Mortality 20.0%

Mean SOFA Score (3.1–4.0): Mortality 36.1%

Mean SOFA Score (4.1–5.0): Mortality 73.1%

Mean SOFA Score (>5.1): Mortality 84.4%

Citation

Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996 Jul;22(7):707-10.

Literature

  • Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996 Jul;22(7):707-10.

    https://pubmed.ncbi.nlm.nih.gov/8844239/

  • Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, Sprung CL, Colardyn F, Blecher S. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Crit Care Med. 1998 Nov;26(11):1793-800.

    https://pubmed.ncbi.nlm.nih.gov/9824069/

  • Ferreira FL, Bota DP, Bross A, Mélot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001 Oct 10;286(14):1754-8.

    https://pubmed.ncbi.nlm.nih.gov/11594901/

  • Cárdenas-Turanzas M, Ensor J, Wakefield C, Zhang K, Wallace SK, Price KJ, Nates JL. Cross-validation of a Sequential Organ Failure Assessment score-based model to predict mortality in patients with cancer admitted to the intensive care unit. J Crit Care. 2012 Dec;27(6):673-80.

    https://pubmed.ncbi.nlm.nih.gov/22762932/

  • Soo A, Zuege DJ, Fick GH, Niven DJ, Berthiaume LR, Stelfox HT, Doig CJ. Describing organ dysfunction in the intensive care unit: a cohort study of 20,000 patients. Crit Care. 2019 May 23;23(1):186.

    https://pubmed.ncbi.nlm.nih.gov/31122276/

  • Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10.

    https://pubmed.ncbi.nlm.nih.gov/26903338/

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