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Purpose <p>The sequential organ failure assessment (SOFA) score was recently updated to better reflect contemporary intensive care. This study compares the predictive validity of the updated SOFA-2 and the previous SOFA-1 for 30-day mortality over the first week in ICU, overall and in subgroups with distinct age and comorbidity profiles.</p> Methods <p>We conducted a retrospective observational study of adult patients admitted to four ICUs in Sweden from 2010 to 2021. Predictive validity for 30-day mortality was assessed on day 1–7 using the area under the receiver operating characteristic curve (AUROC).</p> Results <p>We included 29,820 admissions (mean age 60&#xa0;years, 64.8% males, median Charlson comorbidity index [CCI] 1). Reclassification between SOFA-1 and SOFA-2 occurred in 75–79% of admissions across days 1–7. On day 1, the AUROC for 30-day mortality was 0.81 (95% CI 0.80–0.81) for SOFA-2 and 0.80 (95% CI 0.79–0.81) for SOFA-1 (p &lt; 0.001). From day 2 onward, AUROCs declined for both scores and were largely similar. Among trauma patients (mean age 50&#xa0;years; median CCI 0), day-1 AUROC for SOFA-2 was 0.81 (95% CI 0.79–0.83), while among sepsis patients (mean age 61&#xa0;years; median CCI 3) it was 0.72 (95% CI 0.70–0.74), with comparable performance for SOFA-1.</p> Conclusions <p>SOFA-2 provided modestly better discrimination for 30-day mortality on ICU-day 1 compared with SOFA-1. Predictive validity diminished over subsequent days for both scores and varied across subgroups with different age and comorbidity distributions, underscoring the context-dependence of organ dysfunction scoring.</p> Trial registration <p><a href="https://doi.org/10.5281/zenodo.17651826">https://doi.org/10.5281/zenodo.17651826</a>, registration date November 19, 2025.</p>

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Predictive validity of daily sequential organ failure assessment (SOFA)-2 score for 30-day mortality

  • 期刊论文

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  • 发表日期：

    2026年6月1日

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  • Johan Helleberg,
  • Anna Sundelin,
  • Navid Soltani,
  • Olav Rooyackers,
  • Johan Mårtensson

摘要

Purpose

The sequential organ failure assessment (SOFA) score was recently updated to better reflect contemporary intensive care. This study compares the predictive validity of the updated SOFA-2 and the previous SOFA-1 for 30-day mortality over the first week in ICU, overall and in subgroups with distinct age and comorbidity profiles.

Methods

We conducted a retrospective observational study of adult patients admitted to four ICUs in Sweden from 2010 to 2021. Predictive validity for 30-day mortality was assessed on day 1–7 using the area under the receiver operating characteristic curve (AUROC).

Results

We included 29,820 admissions (mean age 60 years, 64.8% males, median Charlson comorbidity index [CCI] 1). Reclassification between SOFA-1 and SOFA-2 occurred in 75–79% of admissions across days 1–7. On day 1, the AUROC for 30-day mortality was 0.81 (95% CI 0.80–0.81) for SOFA-2 and 0.80 (95% CI 0.79–0.81) for SOFA-1 (p < 0.001). From day 2 onward, AUROCs declined for both scores and were largely similar. Among trauma patients (mean age 50 years; median CCI 0), day-1 AUROC for SOFA-2 was 0.81 (95% CI 0.79–0.83), while among sepsis patients (mean age 61 years; median CCI 3) it was 0.72 (95% CI 0.70–0.74), with comparable performance for SOFA-1.

Conclusions

SOFA-2 provided modestly better discrimination for 30-day mortality on ICU-day 1 compared with SOFA-1. Predictive validity diminished over subsequent days for both scores and varied across subgroups with different age and comorbidity distributions, underscoring the context-dependence of organ dysfunction scoring.

Trial registration

https://doi.org/10.5281/zenodo.17651826, registration date November 19, 2025.