Your SOFA score quantifies the degree of organ dysfunction across six organ systems, with each system scored from 0 (normal function) to 4 (severe dysfunction). A total SOFA score of 0 to 1 indicates minimal or no organ dysfunction with an associated mortality of less than 3%. Scores of 2 to 6 suggest mild to moderate organ dysfunction with mortality ranging from approximately 10% to 20%.

Scores of 7 to 12 indicate significant multi-organ dysfunction with mortality rates of 30% to 50%, and scores of 13 or above are associated with mortality exceeding 50%. Under the Sepsis-3 definitions, an acute increase of 2 or more SOFA points from baseline in a patient with suspected infection constitutes a diagnosis of sepsis. A baseline SOFA of 0 is assumed for patients without known pre-existing organ dysfunction.

Beyond the total score, examining individual organ system scores provides valuable information about which organs are failing and may guide targeted interventions. For example, a high cardiovascular subscore indicates the need for vasopressor support, while a high renal subscore may prompt consideration of renal replacement therapy. The trend in SOFA scores over 24 to 96 hours is one of the strongest predictors of ICU outcome — an increasing SOFA over 48 hours is strongly associated with mortality.

The SOFA score should be calculated for all patients admitted to the ICU, at the time of admission and then every 24 hours throughout the ICU stay. It serves multiple purposes: establishing the severity of illness at admission, tracking the trajectory of organ dysfunction over time, diagnosing sepsis (when an acute SOFA increase of 2 or more occurs with suspected infection), and providing prognostic information to guide goals-of-care discussions.

The SOFA score should also be calculated when qSOFA screening is positive (score of 2 or more) in a patient with suspected infection outside the ICU, as the full SOFA score is required to confirm organ dysfunction and establish a sepsis diagnosis under Sepsis-3 criteria. It is also commonly used in clinical research as a standardized measure of organ dysfunction severity and as a primary or secondary outcome in critical care trials.

The SOFA score requires laboratory values (PaO2, platelets, bilirubin, creatinine) that may not be immediately available, limiting its use as a rapid bedside screening tool — this is why qSOFA was developed as a simpler initial screen. Some SOFA components may be difficult to assess in certain clinical situations: the respiratory component requires an arterial blood gas, the cardiovascular component requires knowledge of vasopressor doses, and urine output measurement requires a urinary catheter.

The SOFA score assumes a baseline of 0 for patients without known pre-existing organ dysfunction, which may not be accurate for patients with chronic kidney disease, chronic liver disease, or chronic respiratory failure. In these patients, the SOFA score may overestimate the degree of acute organ dysfunction. Some institutions calculate a delta-SOFA (change from baseline) to address this issue.

The SOFA score does not capture all aspects of critical illness. It does not assess gastrointestinal function, endocrine dysfunction, or immune status, and it does not account for the specific diagnosis or the reversibility of the underlying condition. Two patients with the same SOFA score may have vastly different prognoses depending on the etiology and trajectory of their illness. The SOFA score should be interpreted in the full clinical context and used alongside clinical judgment.