SOFA score

Sepsis-related Organ Failure Assessment score, also known as Sequential Organ Failure Assessment score (SOFA score), is used to track a person's status during the stay in an intensive care unit (ICU). It is one of several ICU scoring systems.

The SOFA score is a scoring system to determine the extent of a person's organ function or rate of failure.[1][2][3][4][5] The score is based on six different scores, one each for the respiratory, cardiovascular, hepatic, coagulation, renal and neurological systems.

Both the mean and highest SOFA scores are predictors of outcome. An increase in SOFA score during the first 24 to 48 hours in the ICU predicts a mortality rate of at least 50% up to 95%. Scores less than 9 give predictive mortality at 33% while above 11 can be close to or above 95%

The score tables below only describe points-giving conditions. In cases where the physiological parameters do not match any row, zero points are given. In cases where the physiological parameters match more than one row, the row with most points is picked.

It assists health care providors in estimating the risk of morbidity and mortality due to sepsis, the U.S.'s most costly medical condition, which the Centers for Medicare and Medicaid Services will be using as an assessment of the quality of care at a hospital, as an evaluation measurement of patient outcome.[6][7]

Respiratory system

PaO2/FiO2 (mmHg) SOFA score
< 400 1
< 300 2
< 200 and mechanically ventilated 3
< 100 and mechanically ventilated 4

Nervous system

Glasgow coma scale SOFA score
13–14 1
10–12 2
6–9 3
< 6 4

Cardiovascular system

Mean arterial pressure OR administration of vasopressors required SOFA score
MAP < 70 mm/Hg 1
dop ≤ 5 or dob (any dose) 2
dop > 5 OR epi ≤ ;0.1 OR nor ≤ 0.1 3
dop > 15 OR epi > 0.1 OR nor > 0.1 4

(vasopressor drug doses are in µg/kg/min)

Drug abbreviations: dop for dopamine, dob for dobutamine, epi for epinephrine and nor for norepinephrine.

Liver

Bilirubin (mg/dl) [μmol/L] SOFA score
1.2–1.9 [> 20-32] 1
2.0–5.9 [33-101] 2
6.0–11.9 [102-204] 3
> 12.0 [> 204] 4

If bilirubin is less than 1.2, the score is 0

Coagulation

Platelets×103/µl SOFA score
< 150 1
< 100 2
< 50 3
< 20 4

If platelet is more than 150 then score is 0

Kidneys

Creatinine (mg/dl) [μmol/L] (or urine output) SOFA score
1.2–1.9 [110-170] 1
2.0–3.4 [171-299] 2
3.5–4.9 [300-440] (or < 500 ml/d) 3
> 5.0 [> 440] (or < 200 ml/d) 4

Quick SOFA Score

The Quick SOFA Score (quickSOFA or qSOFA) was introduced by the Sepsis-3 group in February 2016 as a simplified version of the SOFA Score as an initial way to identify patients at high risk for poor outcome with an infection. The SIRS Criteria definitions of sepsis are being replaced as they were found to possess too many limitations; the “current use of 2 or more SIRS criteria to identify sepsis was unanimously considered by the task force to be unhelpful.” The qSOFA simplifies the SOFA score drastically by only including its 3 clinical criteria and by including "any altered mentation" instead of requiring a GCS ≤13. qSOFA can easily and quickly be repeated serially on patients.[8]

Assessment qSOFA score
Low blood pressure (SBP ≤ 100 mmHg) 1
High respiratory rate (≥ 22 breaths/min) 1
Altered mentation (GCS < 15) 1

The score ranges from 0 to 3 points. The presence of 2 or more qSOFA points near the onset of infection was associated with a greater risk of death or prolonged intensive care unit stay. These are outcomes that are more common in infected patients who may be septic than those with uncomplicated infection. Based upon these findings, the Third International Consensus Definitions for Sepsis recommends qSOFA as a simple prompt to identify infected patients outside the ICU who are likely to be septic.[9]

References

  1. ↑ 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. PMID 8844239.
  2. ↑ 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. PMID 9824069.
  3. ↑ Moreno R, Vincent JL, Matos R, Mendonça A, Cantraine F, Thijs L, Takala J, Sprung C, Antonelli M, Bruining H, Willatts S. The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Working Group on Sepsis related Problems of the ESICM. Intensive Care Med 1999 Jul;25(7):686-96. PMID 10470572.
  4. ↑ de Mendonça A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M, Takala J, Sprung C, Cantraine F. Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med 2000 Jul;26(7):915-21. PMID 10990106.
  5. ↑ 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. PMID 11594901.
  6. ↑ http://www.msn.com/en-us/health/medical/americas-costliest-health-condition-isnt-what-youd-expect/ar-AAcFurT
  7. ↑ https://oxicmblog.wordpress.com/2015/03/17/isicem-2015-blog-day-1/
  8. ↑ "qSOFA (Quick SOFA Score) for Sepsis Identification - MDCalc". MDCalc. Retrieved 2016-05-29.
  9. ↑ "qSOFA :: What is qSOFA?". www.qsofa.org. Retrieved 2016-05-29.

External links

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