For healthcare professionals
SOFA score calculator
The SOFA (Sequential Organ Failure Assessment) score grades dysfunction in six organ systems from 0 to 4 points each, for a total from 0 to 24. It was built to describe organ dysfunction over time in critically ill patients, and Sepsis-3 uses a rise of 2 or more points to operationalize organ dysfunction in sepsis. This calculator is written for clinicians and is not a diagnosis.
Worst values in the period you are scoring
US units. SOFA is usually scored from the worst value of each item in a 24-hour period. Nothing you enter leaves this page.
What you will see
The total SOFA score from 0 to 24, the PaO2/FiO2 ratio, and the points for each of the six organ systems.
Educational only, not medical advice. Not a diagnosis. Sepsis-3 uses the change in SOFA from the patient's baseline, not a single total.
Source
Vincent JL et al., Intensive Care Medicine 1996, for the original score; the points table as printed in Lambden S et al., Critical Care 2019, Table 1 (modified from Vincent et al.); Singer M et al., JAMA 2016 (Sepsis-3), for the use of a 2-point rise to define organ dysfunction in sepsis. The tests check every cut point in the table.
Validated in
Designed by consensus in 1994 for adult ICU patients and first studied retrospectively, then prospectively in ICUs in 16 countries; later prospective studies in different settings supported its use to track organ dysfunction over time (Lambden 2019).
Limits
SOFA was designed to describe organ dysfunction, not to predict an individual patient's outcome. A single total cannot show whether dysfunction is new or chronic. The central nervous system item is the least reliably scored, especially under sedation. Vasopressor tiers cover dopamine, dobutamine, epinephrine and norepinephrine only. Adults only; not validated in children.
SOFA points table
Each system scores 0 to 4 points and the six scores are added. When a patient's values fit more than one row, the highest-scoring row is used, and values that fit no row score 0 (Lambden 2019) (Vincent 1996).
| System | 0 | 1 | 2 | 3 | 4 |
|---|---|---|---|---|---|
| Respiration: PaO2/FiO2 (mm Hg) | 400 or more | Under 400 | Under 300 | Under 200 with respiratory support | Under 100 with respiratory support |
| Coagulation: platelets (x1,000/microliter) | 150 or more | Under 150 | Under 100 | Under 50 | Under 20 |
| Liver: bilirubin (mg/dL) | Under 1.2 | 1.2 to 1.9 | 2.0 to 5.9 | 6.0 to 11.9 | 12.0 or more |
| Cardiovascular (doses in micrograms/kg/min) | MAP 70 mm Hg or more | MAP under 70 mm Hg | Dopamine 5 or less, or dobutamine (any dose) | Dopamine over 5, or epinephrine 0.1 or less, or norepinephrine 0.1 or less | Dopamine over 15, or epinephrine over 0.1, or norepinephrine over 0.1 |
| Central nervous system: Glasgow Coma Scale | 15 | 13 to 14 | 10 to 12 | 6 to 9 | Under 6 |
| Renal: creatinine (mg/dL) or urine output | Under 1.2 | 1.2 to 1.9 | 2.0 to 3.4 | 3.5 to 4.9, or urine under 500 mL/day | 5.0 or more, or urine under 200 mL/day |
Source: Table 1 of Lambden et al., modified from Vincent et al. (Lambden 2019) (Vincent 1996). A PaO2/FiO2 ratio under 200 without respiratory support scores 2. The table prints the top bilirubin and creatinine rows as "over 12.0" and "over 5.0" next to rows ending at 11.9 and 4.9; this calculator scores exactly 12.0 and 5.0 as 4 points.
How SOFA is used in sepsis
Sepsis-3 defines sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection. For clinical use, organ dysfunction can be represented by an increase in SOFA of 2 points or more, which went with an in-hospital mortality above 10% (Singer 2016). Because the definition uses a change, a patient with chronic organ dysfunction can have a high total without a new rise; in previously healthy patients the baseline can often be taken as 0 (Lambden 2019).
Septic shock is a subset of sepsis. Sepsis-3 identifies it clinically by a vasopressor requirement to keep a mean arterial pressure of 65 mm Hg or more plus a serum lactate above 2 mmol/L despite adequate fluid resuscitation, which went with hospital mortality above 40% (Singer 2016).
Scoring notes
SOFA is usually calculated on ICU admission and then for each 24-hour period, using the most abnormal value of each item in that period (Lambden 2019). Sedation makes the Glasgow Coma Scale hard to assess; the original studies used an assumed pre-sedation value, and some later studies carry forward the last score before sedation (Lambden 2019). Local protocols for sedation and for missing values differ, so totals from different units may not be directly comparable.
Related tools
For a quick bedside prompt outside the ICU, use the qSOFA calculator. To score consciousness for the central nervous system item, use the Glasgow Coma Scale calculator. For liver disease severity, see the MELD score calculator and the Child-Pugh score; for pneumonia severity, the CURB-65 calculator; for acute pancreatitis, the Ranson criteria calculator and the BISAP score calculator.
Sources
- 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. doi:10.1007/BF01709751. PMID 8844239. pubmed.ncbi.nlm.nih.gov/8844239/
- Lambden S, Laterre PF, Levy MM, Francois B. The SOFA score: development, utility and challenges of accurate assessment in clinical trials. Crit Care. 2019;23:374. doi:10.1186/s13054-019-2663-7. PMID 31775846. Open access (CC BY). Table 1 (SOFA criteria) and the sections on development, calculation, the CNS component and defining sepsis. pmc.ncbi.nlm.nih.gov/articles/PMC6880479/
- Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810. doi:10.1001/jama.2016.0287. PMID 26903338. Abstract (SOFA-based definitions of sepsis and septic shock), Box 4 (qSOFA criteria) and section on screening for patients likely to have sepsis. pmc.ncbi.nlm.nih.gov/articles/PMC4968574/
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