Comparison of SOFA-1 and SOFA-2 scales in assessing organ dysfunction and effectiveness of lethality prediction in the critical care unit: a retrospective cohort study

Introduction. In 2025, an updated version of the organ dysfunction assessment scale (SOFA-2) was published; however, the question of whether it should replace the previous version remains open.

The objective was to evaluate whether the modified SOFA-2 scale has advantages over the traditional SOFA-1 scale in assessing the severity of patients with sepsis and predicting outcomes.

Materials and methods. A retrospective analysis of 255 medical records of patients with sepsis (Sepsis-3 criteria) was performed. SOFA-1 and SOFA-2 scores were calculated upon admission to the intensive care unit and on days 1-3. Statistical analysis included the Wilcoxon signed-rank test, Mann-Whitney U test, Bowker’s test of symmetry, McNemar’s test, and ROC analysis.

Results. Median total scores obtained using both scales did not differ significantly at any time point (p > 0.05). Significant redistribution of scores was observed in the cardiovascular and central nervous system components (p < 0.001), while the renal component showed identical results (p > 0.05). The prognostic ability of both scales for in-hospital mortality (32.5%) was comparable: AUROC for SOFA-2 was 0.703 (95% CI 0.666-0.741), and for SOFA-1 was 0.701 (95% CI 0.663-0.740).

Conclusion. SOFA-2 reflects contemporary approaches to intensive care; however, its prognostic value for mortality is practically identical to SOFA-1. The greatest differences are observed in the assessment of cardiovascular and central nervous system components of multiple organ dysfunction. The feasibility of widespread implementation of SOFA-2 for routine use at this stage without additional research is questionable.

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