SOFA (Sequential Organ Failure Assessment) Score


  0 1 2 3 4
Respiration Pao2/fio2(mmhg) >400 <= 400 <= 300 <= 200 et
ventilation mécanique		 <= 100 et
ventilation mécanique
Hemostase Plaquettes(Giga/L) >150 <= 150 <= 100 <= 50 <= 20
Foie Bilirubine (mg/dL) (µmol/L) <1.2 <20 1.2-1.9 20-32 2-5.9 33-101 6-11.9 102-204 >12 >204
Cardiovasculaire   Pression artérielle moyenne<70 mmHg Dopa<= 5 gamma
Dobu		 Dopa >= 5
adrenaline <= 0.1
noradrénaline <= 0.1 gamma/kg/mn		 Dopa >15
adrenaline > 0.1
noradrénaline> 0.1 gamma/kg/mn
Neurologique Glasgow 15 13-14 10-12 6-9 <6
Rein Creatinine (µmol/l) Débit urinaire <110 110-170 171-299 300-440 ou <500ml/jour >440 ou <200 ml/jour


Relation défaillance d'organe >= 3 le jour de l'admission et mortalité

respiratoire hemostase Foie Cardiovasculaire Neurologique Renal
Défaillance isolée
20.7% 16.7% 14.3% 27.9% 24% 23%
respiratoire
60.3% 59% 55.4% 48.1% 57.4%
hemostase
65.6% 69.2% 73.8% 72.3%
Foie
71.2% 67.6% 73.8%
Cardiovasculaire
64.7% 74.3%
Neurologique
66.7%


Commentaires

Ce score de défaillance d'organes à été créé par une commission de la société Européenne de réanimation lors d'une réunion d'experts. Il est conçu pour être utilisé non seulement à l'admission mais tout au long du séjour en réanimation
Il a cependant été testé sur plusieurs bases de données


POUR EN SAVOIR PLUS :


Intensive Care Med 1999 Jul;25(7):686-96
 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.
Moreno R, Vincent JL, Matos R, Mendonca A, Cantraine F, Thijs L, Takala J, Sprung C, Antonelli M, Bruining H, Willatts S
Unidade de Cuidados Intensivos Polivalente, Hospital de St. Antonio dos Capuchos, Lisboa, Portugal. r.moreno@mail.telepac.pt



OBJECTIVE: To evaluate the performance of total maximum sequential organ failure assessment (SOFA) score and a derived measure, delta SOFA (total maximum SOFA score minus admission total SOFA) as a descriptor of multiple organ dysfunction/failure in intensive care. DESIGN: Prospective, multicentre and multinational study. SETTING: Forty intensive care units (ICUs) from Australia, Europe, North and South America. PATIENTS: Data on 1,449 patients, evaluated at admission and then consecutively every 24 h until ICU discharge (11,417 records) during May 1995. Excluded from data collection were all patients with a length of stay in the ICU less than 2 days following uncomplicated scheduled surgery. MAIN OUTCOME MEASURE: Survival status at ICU discharge.



INTERVENTIONS: The collection of raw data necessary for the computation of a SOFA score on admission and then every 24 h, and basic demographic and clinical statistics. MEASUREMENTS AND MAIN RESULTS: Mean total maximum SOFA score presented a very good correlation to ICU outcome, with mortality rates ranging from 3.2% in patients without organ failure to 91.3% in patients with failure of all the six organs analysed. A maximum score was reached 1.1 +/- 0.2 days after admission for all the organ systems analysed. The total maximum SOFA score presented an area under the ROC curve of 0.847 (SE 0.012), which was significantly higher than any of its individual components. The cardiovascular score (odds ratio 1.68) was associated with the highest relative contribution to outcome. No independent contribution could be demonstrated for the hepatic score. No significant interactions were found. Principal components analysis demonstrated the existence of a two-factor structure that became clearer when analysis was limited to the presence or absence of organ failure (SOFA score > or = 3 points) during the ICU stay. The first factor comprises respiratory, cardiovascular and neurological systems and the second coagulation, hepatic and renal systems. Delta SOFA also presented a good correlation to outcome. The area under the receiver operating characteristic (ROC) curve was 0.742 (SE 0.017) for delta SOFA, lower than the total maximum SOFA score or admission total SOFA score. The impact of delta SOFA on prognosis remained significant after correction for admission total SOFA. CONCLUSIONS: The results show that total maximum SOFA score and delta SOFA can be used to quantify the degree of dysfunction/failure already present on ICU admission, the degree of dysfunction/failure that appears during the ICU stay and the cumulative insult suffered by the patient. These properties make it a good instrument to be used in the evaluation of organ dysfunction/failure.




Intensive Care Med 1999 Apr;25(4):389-94
Application of SOFA score to trauma patients. Sequential Organ Failure Assessment.

Antonelli M, Moreno R, Vincent JL, Sprung CL, Mendoca A, Passariello M, Riccioni L, Osborn J

Istituto di Anestesiologia e Rianimazione, Universita La Sapienza Rome, Italy. max.antonelli@flashnet.it



OBJECTIVE: To assess the ability of the SOFA score (Sequential Organ Failure Assessment) to describe the evolution of organ dysfunction/failure in trauma patients over time in intensive care units (ICU). DESIGN: Retrospective analysis of a prospectively collected database. SETTING: 40 ICUs in 16 countries. PATIENTS: All trauma patients admitted to the ICU in May 1995. MAIN OUTCOME MEASURES AND RESULTS: Incidence of dysfunction/failure of different organs during the first 10 days of stay and the relation between the dysfunction, outcome, and length of stay. Included in the SOFA study were 181 trauma patients (140 males and 41 females).The non-survivors were significantly older than the survivors (51 years+/-20 vs 38+/-16 years, p < 0.05) and had a higher global SOFA score on admission (8+/-4 vs 4+/-3, p < 0.05) and throughout the 10-day stay. On admission, the non-survivors had higher scores for respiratory ( > 3 in 47% of non-survivors vs 17% of survivors), cardiovascular ( > 3 in 24% of non-survivors vs 5.7% of survivors), and neurological systems ( > 4 in 41% of non-survivors vs 16% of survivors); although the trend was maintained over the whole study period, the differences were greater during the first 4-5 days. After the first 4 days, only respiratory dysfunction was significantly related to outcome. A higher SOFA score, admission to the ICU from the same hospital, and the presence of infection on admission were the three major variables associated with a longer length of stay in the ICU (additive regression coefficients: 0.85 days for each SOFA point, 4.4 for admission from the same hospital, 7.26 for infection on admission). CONCLUSIONS: The SOFA score can reliably describe organ dysfunction/ failure in trauma patients. Regular and repeated scoring may be helpful for identifying categories of patients at major risk of prolonged ICU stay or death.



Crit Care Med 1998 Nov;26(11):1793-800
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.
Vincent JL, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter PM, Sprung CL, Colardyn F, Blecher S
Department of Intensive Care, Erasme University Hospital, Brussels, Belgium. jlvincen@ulb.ac.be

OBJECTIVE: To evaluate the use of the Sequential Organ Failure Assessment (SOFA) score in assessing the incidence and severity of organ dysfunction in critically ill patients. DESIGN: Prospective, multicenter study. SETTING: Forty intensive care units (ICUs) in 16 countries. PATIENTS: Patients admitted to the ICU in May 1995 (n = 1,449), excluding patients who underwent uncomplicated elective surgery with an ICU length of stay <48 hrs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The main outcome measures included incidence of dysfunction/failure of different organs and the relationship of this dysfunction with outcome. In this cohort of patients, the median length of ICU stay was 5 days, and the ICU mortality rate was 22%. Multiple organ dysfunction and high SOFA scores for any individual organ were associated with increased mortality. The presence of infection on admission (28.7% of patients) was associated with higher SOFA scores for each organ. The evaluation of a subgroup of 544 patients who stayed in the ICU for at least 1 wk showed that survivors and nonsurvivors followed a different course. This subgroup had greater respiratory, cardiovascular, and neurologic scores than the other patients. In this subgroup, the total SOFA score increased in 44% of the nonsurvivors but in only 20% of the survivors (p < .001). Conversely, the total SOFA score decreased in 33% of the survivors compared with 21% of the nonsurvivors (p < .001). CONCLUSIONS: The SOFA score is a simple, but effective method to describe organ dysfunction/failure in critically ill patients. Regular, repeated scoring enables patient condition and disease development to be monitored and better understood. The SOFA score may enable comparison between patients that would benefit clinical trials.