Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American Medical Association https://doi.org/10.1001/jama.2025.20516 Dr. Otavio T. Ranzani et al.
Points
- The international SOFA score for assessing organ dysfunction in critically ill patients has been updated after three decades.
- SOFA-2 incorporates advances in diagnostics, monitoring, and life support to more accurately reflect current clinical practice.
- The study analyzed over 3.3 million ICU admissions from nine countries, making it the largest review of organ dysfunction measurement.
- SOFA-2 maintains six organ systems but redefines scoring thresholds and updates variables, including new life support therapies.
- The new model achieves a more uniform gradation of severity and improved predictive validity for clinical outcomes.
Summary
The SOFA-2 Study Group, led by Dr. Otavio Ranzani, conducted a comprehensive update of the Sequential Organ Failure Assessment (SOFA) score, a widely adopted tool for describing organ dysfunction in critically ill patients, which had not been revised in 30 years. This federated analysis encompassed data from 3.34 million ICU admissions (2,098,356 for development and 1,241,114 for external validation) across 1319 intensive care units in 9 countries (Australia, Austria, Brazil, France, Italy, Japan, Nepal, New Zealand, United States) between 2014 and 2023.
The SOFA-2 score maintains the original six organ systems (brain, respiratory, cardiovascular, liver, kidney, hemostasis) but incorporates new variables and revised thresholds to reflect contemporary intensive care practices, including noninvasive ventilation, continuous renal replacement therapies, extracorporeal membrane oxygenation (ECMO), and high-flow oxygen therapy. The updated score demonstrated improved predictive validity for ICU mortality, with an Area Under the Receiver Operating Characteristic (AUROC) curve of 0.79 (95% CI, 0.76-0.81) for SOFA-2, compared to 0.77 (95% CI, 0.74-0.81) for the original SOFA-1.
Among the 3.34 million patient encounters, 270,108 (8.1%) died in the ICU. The sequential evaluation of SOFA-2 data from ICU day 1 to day 7 maintained its predictive validity. Despite efforts, insufficient data precluded the incorporation of gastrointestinal and immune dysfunction scores into SOFA-2. This updated SOFA-2 score provides a more accurate and consistent language for describing organ dysfunction in a diverse global critically ill adult population, setting a new benchmark for clinical practice and research in critical care.
Link to the article: https://jamanetwork.com/journals/jama/fullarticle/2840822
References
Ranzani, O. T., Singer, M., Salluh, J. I. F., Shankar-Hari, M., Pilcher, D., Berger-Estilita, J., Coopersmith, C. M., Juffermans, N. P., Laffey, J., Reinikainen, M., Neto, A. S., Tavares, M., Timsit, J.-F., Arias Lopez, M. D. P., Arulkumaran, N., Aryal, D., Azoulay, E., Celi, L. A., Chaudhuri, D., … Moreno, R. (2025). Development and validation of the sequential organ failure assessment (Sofa)-2 score. JAMA. https://doi.org/10.1001/jama.2025.20516
