SOFA score
Sequential (Sepsis-related) Organ Failure Assessment — organ dysfunction for the Sepsis-3 definition
- ESICM 1996
- Sepsis-3 2016
- AWMF S3 Sepsis 2025
Sources last checked: 2026-10-13
SOFA score
Sequential (Sepsis-related) Organ Failure Assessment — organ dysfunction for the Sepsis-3 definition
Sepsis-3 uses the change from baseline: assume a baseline of 0 only when no pre-existing organ dysfunction is known. Score the worst value in the observation period (commonly 24 h). This is the original 1996 SOFA used by Sepsis-3; SOFA-2 (JAMA 2025) revises several organ thresholds and is not interchangeable.
Interpretation
| 0–1 | Below the Sepsis-3 threshold if the baseline is 0. Organ function can deteriorate quickly in infection; a single score is a snapshot. |
|---|---|
| ≥ 2 — organ dysfunction | An acute increase of ≥ 2 points from baseline in suspected infection defines sepsis-related organ dysfunction (Sepsis-3; AWMF S3 Sepsis 2025); in infected patients outside the ICU this corresponds to an in-hospital mortality > 10 %. |
What is the SOFA score?
The SOFA score grades dysfunction of six organ systems from 0 to 4 points each (total 0–24). It was introduced in 1996 by Vincent and the ESICM working group on sepsis to describe organ failure in intensive-care patients. Since Sepsis-3 (2016), an acute rise of 2 or more points in suspected infection defines sepsis.
When to use it
- Operationalising the Sepsis-3 definition in patients with suspected infection.
- Describing and tracking organ dysfunction over the ICU course.
- Research and quality-assurance documentation of sepsis severity.
When not to use it
- Rapid bedside screening on the ward — it needs blood gas and laboratory values; use qSOFA or NEWS2 for triage.
- Comparing with SOFA-2 values — the 2025 revision uses different thresholds.
- Chronic stable organ failure without a defined baseline, where the change cannot be interpreted.
How it is calculated
| Criterion | Points |
|---|---|
| Respiration: PaO₂/FiO₂ | |
| ≥ 400 mmHg (≥ 53.3 kPa) | 0 |
| < 400 mmHg (< 53.3 kPa) | 1 |
| < 300 mmHg (< 40 kPa) | 2 |
| < 200 mmHg (< 26.7 kPa) with respiratory support | 3 |
| < 100 mmHg (< 13.3 kPa) with respiratory support | 4 |
| Coagulation: platelets (× 10⁹/L) | |
| ≥ 150 | 0 |
| 100–149 | 1 |
| 50–99 | 2 |
| 20–49 | 3 |
| < 20 | 4 |
| Liver: bilirubin | |
| < 20 µmol/L (< 1.2 mg/dL) | 0 |
| 20–32 µmol/L (1.2–1.9 mg/dL) | 1 |
| 33–101 µmol/L (2.0–5.9 mg/dL) | 2 |
| 102–204 µmol/L (6.0–11.9 mg/dL) | 3 |
| > 204 µmol/L (> 12.0 mg/dL) | 4 |
| Cardiovascular: hypotension / vasopressors | |
| MAP ≥ 70 mmHg, no vasopressor | 0 |
| MAP < 70 mmHg | 1 |
| Dopamine ≤ 5 or dobutamine (any dose) | 2 |
| Dopamine > 5, or adrenaline ≤ 0.1, or noradrenaline ≤ 0.1 | 3 |
| Dopamine > 15, or adrenaline > 0.1, or noradrenaline > 0.1 | 4 |
| Central nervous system: Glasgow Coma Scale | |
| 15 | 0 |
| 13–14 | 1 |
| 10–12 | 2 |
| 6–9 | 3 |
| < 6 | 4 |
| Renal: creatinine or urine output | |
| < 110 µmol/L (< 1.2 mg/dL) | 0 |
| 110–170 µmol/L (1.2–1.9 mg/dL) | 1 |
| 171–299 µmol/L (2.0–3.4 mg/dL) | 2 |
| 300–440 µmol/L (3.5–4.9 mg/dL) or urine output < 500 mL/day | 3 |
| > 440 µmol/L (> 5.0 mg/dL) or urine output < 200 mL/day | 4 |
Clinical pearls and limitations
- Sepsis-3 uses the change from baseline: assume a baseline of 0 only when no pre-existing organ dysfunction is known. Score the worst value in the observation period (commonly 24 h). This is the original 1996 SOFA used by Sepsis-3; SOFA-2 (JAMA 2025) revises several organ thresholds and is not interchangeable.
- Sepsis-3 uses the change (Δ SOFA ≥ 2) from the patient's baseline, not the absolute total.
- Use the worst value of each component in the observation period, typically 24 hours.
- Catecholamine doses are in µg/kg/min and must have been given for at least one hour.
- In sedated patients score the GCS presumed without sedation.
- Renal points can come from creatinine or from urine output — use whichever scores higher.
Frequently asked questions
What SOFA score means sepsis?
An acute increase of at least 2 points from baseline in a patient with infection — associated with an in-hospital mortality above 10 % in infected ward patients.
What is the difference between SOFA and qSOFA?
qSOFA uses three bedside signs to flag risk outside the ICU; SOFA quantifies organ dysfunction with lab values and defines sepsis.
What is SOFA-2?
A 2025 revision (JAMA) with updated organ thresholds and treatments. This calculator implements the original 1996 SOFA used in the Sepsis-3 definition.
Which bilirubin and creatinine units does SOFA use?
The original table gives mg/dL; µmol/L equivalents are shown alongside each option here, so no conversion is needed.
Evidence and guidelines
- Primary source: Vincent JL, Moreno R, Takala J et al. 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;22(7):707-710.
- Singer M et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315(8):801-810.
- Deutsche Sepsis-Gesellschaft. S3-Leitlinie Sepsis – Prävention, Diagnose, Therapie und Nachsorge, Update 2025 (AWMF-Register 079-001), Definition 1.
- Ranzani OT et al. Development and validation of the Sequential Organ Failure Assessment (SOFA)-2 score. JAMA 2025;334:2090-2103.
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