ArticleCritical care (London, England)2026
Performance of sequential organ failure assessment 1 versus 2 for sepsis identification in patients with suspected infection: a multicenter retrospective cohort study.
Article in Critical care (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Validation of the updated sequential organ failure assessment (SOFA)-2 score in emergency department septic shock.Journal of intensive care · 2026Article
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15 authors.
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Abstract
objectiveThe revised Sequential Organ Failure Assessment (SOFA-2) score was recently developed to update definitions of acute organ dysfunction in intensive care units (ICU). This study aimed to evaluate performance between SOFA-1 and SOFA-2 definition for sepsis identification in patients with suspected infection.
methodsWe analyzed 24,510 patients with suspected infection in Chinese multicenter cohort and validated in the MIMIC-IV database. Patients were divided into four categories based on concordance between SOFA versions: SOFA-1(-)/SOFA-2(-), SOFA-1(+)/SOFA-2(+), SOFA-1(-)/SOFA-2(+), and SOFA-1(+)/SOFA-2(-). Kaplan-Meier analyses and cox proportional hazards models assessed the associations with in-hospital mortality.
resultsMost patients met sepsis criteria under both SOFA versions (18,179/24,510; 74.2%[95% confidential interval (CI), 73.6%-74.7%]), while 9.9% (95% CI, 9.53%-10.2%) were classified as SOFA-1(+)/SOFA-2(-), 5.5% (95% CI, 5.2%-5.8%) as SOFA-1(-)/SOFA-2(+), and 10.2% (95% CI, 9.8%-10.6%) as SOFA-1(-)/SOFA-2(-). Patients in SOFA-1(-)/SOFA-2(+) group were younger, more often male, higher rates of pneumonia, gastrointestinal infection, and neurologic infection. Superior discrimination for in-hospital mortality was observed in SOFA-2 [area under the receiver operating characteristic curve (AUROC) 0.746; 95% confidence interval (CI) 0.737-0.756] compared with SOFA-1 (0.679; 95% CI 0.668-0.689). In-hospital mortality was markedly higher in SOFA-2 (+) groups [2.9% in SOFA-1(-)/SOFA-2(-), 3.3% in SOFA-1(+)/SOFA-2(-), 10.6% in SOFA-1(-)/SOFA-2(+), and 14.3% in SOFA-1(+)/SOFA-2(+); p < 0.001]. Compared with SOFA-1(-)/SOFA-2(-), the hazard ratios for in-hospital mortality were 0.99 (95% CI, 0.72-1.36) for SOFA-1(+)/SOFA-2(-), 3.52 (95% CI, 2.66-4.67) for SOFA-1(-)/SOFA-2(+), and 4.44 (95% CI, 3.52-5.60) for SOFA-1(+)/SOFA-2(+). These patterns were consistent in sensitivity analyses.
conclusionSOFA-2-based sepsis identified a clinically meaningful higher-risk subgroup, with consistent results across sensitivity analyses. Nevertheless, cohort-specific differences emphasize the need for cautious interpretation and further validation in diverse clinical settings.
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