What is the SOFA score in Sepsis-3?

Under the Sepsis-3 definition (Singer et al., JAMA 2016), sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Organ dysfunction is defined as an acute change in total SOFA score ≥2 points from baseline in a patient with suspected infection. A SOFA score ≥2 is associated with an in-hospital mortality risk of approximately 10% in general hospital populations with suspected infection. The SOFA score evaluates 6 organ systems: respiratory (P/F ratio), coagulation (platelets), hepatic (bilirubin), cardiovascular (MAP and vasopressors), CNS (GCS), and renal (creatinine or urine output).

What SOFA score indicates high mortality?

SOFA score mortality estimates: Score 0–6 = 80% ICU mortality. These are population-level estimates from the original Vincent et al. (1998) validation and subsequent multicenter studies. The trend of SOFA over 48–72 hours is more prognostically important than a single value — increasing SOFA correlates with worsening mortality; decreasing SOFA with improving prognosis.

What is the difference between SOFA and qSOFA?

qSOFA (quick SOFA) is a simplified 3-criteria bedside screening tool used outside the ICU: altered mental status + respiratory rate ≥22/min + systolic BP ≤100 mmHg. A qSOFA score ≥2 identifies patients outside the ICU who may have sepsis and should prompt further assessment with the full SOFA score. The full SOFA score requires laboratory values (bilirubin, creatinine, platelets) and is the gold standard for formal sepsis diagnosis and ICU organ failure monitoring. qSOFA is NOT recommended as a sole diagnostic criterion for sepsis — it is a screening tool only.

How often should SOFA be calculated in the ICU?

SOFA score should be calculated daily (every 24 hours) in ICU patients with suspected or confirmed sepsis. More frequent calculation (every 12 hours) may be appropriate in rapidly deteriorating patients. The 48-hour trend is the most clinically meaningful indicator: an increase ≥2 points over 48 hours is associated with significantly higher mortality; a decrease ≥2 points suggests favorable response to treatment. Document the baseline SOFA on ICU admission and the worst SOFA within the first 24 hours of sepsis recognition.

What is the SOFA score in Sepsis-3?

Under the Sepsis-3 definition (Singer et al., JAMA 2016), sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Organ dysfunction is defined as an acute change in total SOFA score ≥2 points from baseline in a patient with suspected infection. A SOFA score ≥2 is associated with an in-hospital mortality risk of approximately 10% in general hospital populations with suspected infection. The SOFA score evaluates 6 organ systems: respiratory (P/F ratio), coagulation (platelets), hepatic (bilirubin), cardiovascular (MAP and vasopressors), CNS (GCS), and renal (creatinine or urine output).

What SOFA score indicates high mortality?

SOFA score mortality estimates: Score 0–6 = 80% ICU mortality. These are population-level estimates from the original Vincent et al. (1998) validation and subsequent multicenter studies. The trend of SOFA over 48–72 hours is more prognostically important than a single value — increasing SOFA correlates with worsening mortality; decreasing SOFA with improving prognosis.

What is the difference between SOFA and qSOFA?

qSOFA (quick SOFA) is a simplified 3-criteria bedside screening tool used outside the ICU: altered mental status + respiratory rate ≥22/min + systolic BP ≤100 mmHg. A qSOFA score ≥2 identifies patients outside the ICU who may have sepsis and should prompt further assessment with the full SOFA score. The full SOFA score requires laboratory values (bilirubin, creatinine, platelets) and is the gold standard for formal sepsis diagnosis and ICU organ failure monitoring. qSOFA is NOT recommended as a sole diagnostic criterion for sepsis — it is a screening tool only.

How often should SOFA be calculated in the ICU?

SOFA score should be calculated daily (every 24 hours) in ICU patients with suspected or confirmed sepsis. More frequent calculation (every 12 hours) may be appropriate in rapidly deteriorating patients. The 48-hour trend is the most clinically meaningful indicator: an increase ≥2 points over 48 hours is associated with significantly higher mortality; a decrease ≥2 points suggests favorable response to treatment. Document the baseline SOFA on ICU admission and the worst SOFA within the first 24 hours of sepsis recognition.

SOFA Score Calculator | Sequential Organ Failure Assessment & Sepsis-3 Criteria

SOFA Score Calculator

Sequential Organ Failure Assessment — score all 6 organ systems to calculate ICU mortality risk and assess the Sepsis-3 organ dysfunction criterion (acute SOFA ≥2 = organ dysfunction). Daily trend tracking and EMR-ready documentation.

NM Clinically reviewed byDr. Nikhil Mahajan, PT, MPT · Jan 15, 2025

SOFA Score — ICU Mortality Reference

SOFA Score	Dysfunction Level	Estimated ICU Mortality
0–6	Low Dysfunction	<10%
7–9	Moderate Dysfunction	15–20%
10–12	Significant Dysfunction	40–50%
13–14	Severe Dysfunction	50–60%
≥15	Critical — Very High Mortality	>80%

SOFA Score

Dysfunction Level

Estimated ICU Mortality

0–6

Low Dysfunction

<10%

7–9

Moderate Dysfunction

15–20%

10–12

Significant Dysfunction

40–50%

13–14

Severe Dysfunction

50–60%

≥15

Critical — Very High Mortality

>80%

Mortality estimates from Vincent JL et al. Crit Care Med. 1998 and subsequent multicenter validation. SOFA trend over 48h is more predictive than any single value — document daily.

SOFA Scoring — Complete Criteria Reference

Organ System	Score 0	Score 1	Score 2	Score 3	Score 4
🫁 Respiratory PaO₂/FiO₂ Ratio (P/F Ratio) — from ABG	P/F ratio > 400 mmHg — normal oxygenation	P/F ratio 301–400 mmHg	P/F ratio 201–300 mmHg	P/F ratio 101–200 mmHg with mechanical ventilation	P/F ratio ≤ 100 mmHg with mechanical ventilation
🩸 Coagulation Platelet Count (×10³/µL)	Platelets ≥ 150 ×10³/µL	Platelets 101–149 ×10³/µL	Platelets 51–100 ×10³/µL	Platelets 21–50 ×10³/µL	Platelets ≤ 20 ×10³/µL — DIC risk
🟡 Hepatic Serum Bilirubin (mg/dL)	Bilirubin < 1.2 mg/dL	Bilirubin 1.2–1.9 mg/dL	Bilirubin 2.0–5.9 mg/dL	Bilirubin 6.0–11.9 mg/dL — hepatic failure	Bilirubin ≥ 12.0 mg/dL — severe hepatic failure
❤️ Cardiovascular MAP and Vasopressor Requirement	MAP ≥ 70 mmHg — no vasopressors	MAP < 70 mmHg — no vasopressors	Dopamine ≤ 5 mcg/kg/min OR any dobutamine dose	Dopamine 5.1–15 mcg/kg/min OR epinephrine ≤ 0.1 OR norepinephrine ≤ 0.1 mcg/kg/min	Dopamine > 15 mcg/kg/min OR epinephrine > 0.1 OR norepinephrine > 0.1 mcg/kg/min
🧠 Neurological Glasgow Coma Scale (GCS)	GCS 15 — fully alert and oriented	GCS 13–14 — minor cognitive deficit	GCS 10–12 — moderate neurological dysfunction	GCS 6–9 — severe CNS dysfunction	GCS < 6 — deep coma, minimal or no response
🔬 Renal Creatinine (mg/dL) or Urine Output	Creatinine < 1.2 mg/dL — normal renal function	Creatinine 1.2–1.9 mg/dL	Creatinine 2.0–3.4 mg/dL	Creatinine 3.5–4.9 mg/dL OR urine output < 500 mL/day	Creatinine ≥ 5.0 mg/dL OR urine output < 200 mL/day

Organ System

Score 0

Score 1

Score 2

Score 3

Score 4

🫁 Respiratory
PaO₂/FiO₂ Ratio (P/F Ratio) — from ABG

P/F ratio > 400 mmHg — normal oxygenation

P/F ratio 301–400 mmHg

P/F ratio 201–300 mmHg

P/F ratio 101–200 mmHg with mechanical ventilation

P/F ratio ≤ 100 mmHg with mechanical ventilation

🩸 Coagulation
Platelet Count (×10³/µL)

Platelets ≥ 150 ×10³/µL

Platelets 101–149 ×10³/µL

Platelets 51–100 ×10³/µL

Platelets 21–50 ×10³/µL

Platelets ≤ 20 ×10³/µL — DIC risk

🟡 Hepatic
Serum Bilirubin (mg/dL)

Bilirubin < 1.2 mg/dL

Bilirubin 1.2–1.9 mg/dL

Bilirubin 2.0–5.9 mg/dL

Bilirubin 6.0–11.9 mg/dL — hepatic failure

Bilirubin ≥ 12.0 mg/dL — severe hepatic failure

❤️ Cardiovascular
MAP and Vasopressor Requirement

MAP ≥ 70 mmHg — no vasopressors

MAP < 70 mmHg — no vasopressors

Dopamine ≤ 5 mcg/kg/min OR any dobutamine dose

Dopamine 5.1–15 mcg/kg/min OR epinephrine ≤ 0.1 OR norepinephrine ≤ 0.1 mcg/kg/min

Dopamine > 15 mcg/kg/min OR epinephrine > 0.1 OR norepinephrine > 0.1 mcg/kg/min

🧠 Neurological
Glasgow Coma Scale (GCS)

GCS 15 — fully alert and oriented

GCS 13–14 — minor cognitive deficit

GCS 10–12 — moderate neurological dysfunction

GCS 6–9 — severe CNS dysfunction

GCS < 6 — deep coma, minimal or no response

🔬 Renal
Creatinine (mg/dL) or Urine Output

Creatinine < 1.2 mg/dL — normal renal function

Creatinine 1.2–1.9 mg/dL

Creatinine 2.0–3.4 mg/dL

Creatinine 3.5–4.9 mg/dL OR urine output < 500 mL/day

Creatinine ≥ 5.0 mg/dL OR urine output < 200 mL/day

SOFA Score — Clinical Reference for Sepsis and Organ Failure

The Sequential Organ Failure Assessment (SOFA) score was developed by Vincent et al. (1996) to objectively quantify the degree of organ dysfunction in ICU patients over time. It scores 6 organ systems — respiratory, coagulation, hepatic, cardiovascular, neurological, and renal — on a scale of 0 to 4 each, for a maximum total of 24 points. The Sepsis-3 consensus (Singer et al., JAMA 2016) adopted the SOFA score as the formal criterion for organ dysfunction in sepsis — an acute increase of ≥2 SOFA points from baseline in a patient with suspected infection meets the diagnostic threshold for sepsis.

The Six SOFA Organ Systems — Scoring Logic

🫁 Respiratory (PaO₂/FiO₂ Ratio (P/F Ratio) — from ABG): P/F ratio > 400 mmHg — normal oxygenation = 0 pts; P/F ratio 201–300 mmHg = 2 pts; P/F ratio ≤ 100 mmHg with mechanical ventilation = 4 pts (maximum).
🩸 Coagulation (Platelet Count (×10³/µL)): Platelets ≥ 150 ×10³/µL = 0 pts; Platelets 51–100 ×10³/µL = 2 pts; Platelets ≤ 20 ×10³/µL — DIC risk = 4 pts (maximum).
🟡 Hepatic (Serum Bilirubin (mg/dL)): Bilirubin < 1.2 mg/dL = 0 pts; Bilirubin 2.0–5.9 mg/dL = 2 pts; Bilirubin ≥ 12.0 mg/dL — severe hepatic failure = 4 pts (maximum).
❤️ Cardiovascular (MAP and Vasopressor Requirement): MAP ≥ 70 mmHg — no vasopressors = 0 pts; Dopamine ≤ 5 mcg/kg/min OR any dobutamine dose = 2 pts; Dopamine > 15 mcg/kg/min OR epinephrine > 0.1 OR norepinephrine > 0.1 mcg/kg/min = 4 pts (maximum).
🧠 Neurological (Glasgow Coma Scale (GCS)): GCS 15 — fully alert and oriented = 0 pts; GCS 10–12 — moderate neurological dysfunction = 2 pts; GCS < 6 — deep coma, minimal or no response = 4 pts (maximum).
🔬 Renal (Creatinine (mg/dL) or Urine Output): Creatinine < 1.2 mg/dL — normal renal function = 0 pts; Creatinine 2.0–3.4 mg/dL = 2 pts; Creatinine ≥ 5.0 mg/dL OR urine output < 200 mL/day = 4 pts (maximum).

SOFA Trend — More Important Than a Single Value

A single SOFA score is a mortality estimate. The 48-hour trend is far more prognostically informative. An increasing SOFA score over 48 hours indicates worsening organ dysfunction and correlates with significantly higher mortality — a SOFA increase ≥2 over 48 hours approximately doubles hospital mortality regardless of the starting score. A decreasing SOFA indicates positive response to treatment. In sepsis management, daily SOFA tracking is essential to guide treatment escalation or de-escalation.

Sepsis-3 — Using SOFA for Diagnosis

Under Sepsis-3, sepsis is suspected when a patient has: (1) a known or suspected infection AND (2) an acute SOFA increase ≥2 points from baseline. If baseline is unknown, assume baseline SOFA = 0. A SOFA ≥2 is associated with approximately 10% in-hospital mortality — the threshold chosen to balance sensitivity and specificity for a condition requiring urgent treatment. Septic shock is defined as sepsis PLUS vasopressor requirement to maintain MAP ≥65 mmHg AND serum lactate >2 mmol/L despite adequate fluid resuscitation.

NM Dr. Nikhil Mahajan, PT, MPT · Reviewed January 15, 2025 · View credentials

Frequently Asked Questions

What is the difference between SOFA and APACHE II for ICU prognosis?

SOFA and APACHE II serve different purposes. APACHE II is calculated once at ICU admission (worst 24-hour values) to predict overall hospital mortality — it is a static prognosis tool used for benchmarking. SOFA is calculated daily to track organ failure trajectory over time — it is a dynamic monitoring tool. SOFA is integral to the Sepsis-3 definition; APACHE II is not. For research stratification and quality benchmarking, APACHE II remains widely used. For daily sepsis management and treatment response assessment, SOFA is the preferred instrument.

How is the cardiovascular SOFA scored for patients on vasopressors?

The cardiovascular SOFA component is the most complex to score because it depends on which vasopressor is used and at what dose (all doses in mcg/kg/min, administered for ≥1 hour): Score 0 = MAP ≥70 mmHg, no vasopressors; Score 1 = MAP <70 mmHg, no vasopressors; Score 2 = Dopamine ≤5 OR dobutamine (any dose); Score 3 = Dopamine 5–15 OR epinephrine ≤0.1 OR norepinephrine ≤0.1; Score 4 = Dopamine >15 OR epinephrine >0.1 OR norepinephrine >0.1. Vasopressin at the fixed septic shock dose (0.03 units/min) is not scored separately — it replaces norepinephrine at the equivalence conversion.

Can SOFA be used in non-sepsis ICU patients?

Yes — SOFA was originally developed as a general organ failure assessment tool for all ICU patients, not specifically for sepsis. It provides valid mortality predictions in non-sepsis ICU patients (trauma, post-operative, burns, cardiac arrest). The Sepsis-3 application of SOFA for sepsis diagnosis is a specific use case — the SOFA score itself measures organ failure regardless of cause. For non-sepsis patients, the absolute SOFA value and trend remain useful prognostic and clinical monitoring tools independent of the infection context.

What is the relationship between SOFA and qSOFA in the ED?

qSOFA (quick SOFA) is a 3-item bedside screening tool for patients outside the ICU: altered mental status + RR ≥22/min + SBP ≤100 mmHg. Score ≥2 identifies patients at risk for poor outcomes and should prompt clinical assessment for sepsis, transfer to a higher-acuity setting, and calculation of the full SOFA score. qSOFA has low sensitivity (35–50%) for sepsis — a negative qSOFA does NOT rule out sepsis. The full SOFA score should be calculated whenever sepsis is suspected, regardless of qSOFA result. The Surviving Sepsis Campaign recommends against using qSOFA as the sole criterion for sepsis recognition.

SOFA Score Calculator

Score All 6 Organ Systems

Respiratory System

Coagulation System

Hepatic System

Cardiovascular System

Neurological System

Renal System

Clinical Interpretation