What is the Sequential [sepsis-related] Organ Failure Assessment (SOFA) score and how is it used in the diagnosis of multiple organ dysfunction syndrome in sepsis?

Updated: Jan 27, 2020
  • Author: Ali H Al-Khafaji, MD, MPH, FACP, FCCP, FCCM; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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In early 2016, the Society of Critical Care Medicine and the European Society of Intensive Care Medicine convened a task force to address definitions and clinical criteria for sepsis. [4] The task force concluded that sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Organ dysfunction is represented by an increase in the Sequential [sepsis-related] Organ Failure Assessment (SOFA) score [5] of 2 points or more, which is associated with an in-hospital mortality greater than 10%.

Septic shock is defined as a subset of sepsis in which profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone.

Patients with septic shock can be clinically identified by a vasopressor requirement to maintain a mean arterial pressure of 65 mm Hg or greater and serum lactate level greater than 2 mmol/L (>18 mg/dL) in the absence of hypovolemia. This combination is associated with hospital mortality rates greater than 40%.

In out-of-hospital, emergency department, or general hospital ward settings, adult patients with suspected infection can be rapidly identified as being more likely to have poor outcomes typical of sepsis if they have at least two of the following clinical criteria that together constitute a new bedside clinical score termed quick SOFA (qSOFA) [6] : respiratory rate of 22/min or greater, altered mentation, or systolic blood pressure of 100 mm Hg or less.

The task force recommended that these updated definitions and clinical criteria should replace previous definitions

MODS is the presence of altered organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention. Primary MODS is the direct result of a well-defined insult in which organ dysfunction occurs early and can be directly attributable to the insult itself. Secondary MODS develops as a consequence of a host response and is identified within the context of SIRS. The inflammatory response of the body to toxins and other components of microorganisms causes the clinical manifestations of sepsis.

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