External validation of SOFA 2 score: a retrospective Chinese cohort study

Area of Science:

• Critical Care Medicine
• Clinical Epidemiology
• Health Services Research

Background:

• The Sequential Organ Failure Assessment (SOFA) score is crucial for assessing organ dysfunction.
• Limitations in data availability in resource-limited settings prompted the development of the revised SOFA 2 score.
• Early identification of acute organ dysfunction is vital for patient outcomes.

Purpose of the Study:

• To compare the performance of the original SOFA-1 and the revised SOFA-2 scores.
• To evaluate the utility of SOFA-2 in resource-limited intensive care units (ICUs).
• To assess the discriminative ability of SOFA scores for ICU mortality.

Main Methods:

• Retrospective multicenter analysis of 118,542 adult ICU patients (2014-2024).
• SOFA scores calculated using clinical data from the first seven ICU days.
• Area Under the Receiver Operating Characteristic Curve (AUROC) used to assess discriminative performance.

Main Results:

• SOFA-2 demonstrated significantly better discrimination for ICU mortality than SOFA-1 (AUROC 80.9% vs. 76.7%).
• Higher SOFA-2 scores correlated with increased ICU mortality (OR 1.33 per point increase).
• SOFA-2 exhibited lower between-cohort variance, indicating greater robustness.

Conclusions:

• SOFA-2 offers improved discrimination for ICU mortality and more consistent score distribution than SOFA-1.
• The findings support the broader applicability of SOFA-2 across diverse healthcare settings, including resource-constrained environments.
• SOFA-2 is a more reliable tool for early identification of organ dysfunction and prediction of mortality.