Comparative Prognostic Performance of SOFA2.0 and SOFA for 28-Day Mortality in Patients Developing Sepsis During ECMO...

The Sequential Organ Failure Assessment (SOFA) score is widely used to evaluate organ dysfunction in sepsis, but its performance may be affected in patients receiving extracorporeal membrane oxygenation (ECMO), where extracorporeal support and related therapies can alter physiologic parameters. An updated version, SOFA2.0, has been proposed to better reflect organ dysfunction in contemporary critical care. This study compared the prognostic performance of SOFA2.0 and traditional SOFA in patients who developed sepsis during ECMO support.

We conducted a single-center retrospective cohort study including adult patients who developed sepsis during ECMO support between January 2021 and December 2024. SOFA and SOFA2.0 scores were calculated at the time of Sepsis-3 diagnosis using the same clinical dataset. The primary outcome was 28-day mortality. Predictive performance was evaluated using receiver operating characteristic analysis, multivariable logistic regression, and reclassification metrics including net reclassification improvement (NRI) and integrated discrimination improvement (IDI).

Fifty-three patients were included, with a median age of 54.0 years (IQR, 46.0-61.0), 79.2% male patients, and a 28-day mortality rate of 67.9%. Both SOFA and SOFA2.0 scores were significantly higher in non-survivors than in survivors. SOFA2.0 demonstrated a numerically higher AUC than SOFA (0.765 [95% CI: 0.635-0.896] vs. 0.719 [95% CI: 0.573-0.865]), although the confidence intervals overlapped. Reclassification analysis showed positive continuous NRI (0.728) and IDI (0.071), indicating numerically favorable reclassification performance for SOFA2.0 compared with traditional SOFA. However, SOFA2.0 was not independently associated with mortality after multivariable adjustment.

In patients who developed sepsis during ECMO support, SOFA2.0 demonstrated comparable discriminatory performance to traditional SOFA, without clear evidence of superiority. Although SOFA2.0 showed numerically favorable discrimination and reclassification metrics, these findings should be interpreted cautiously given the limited sample size and single-center design.