Dr. Otavio Ranzani. Credit score: IR Sant Pau
The up to date model of the Sequential Organ Failure Evaluation (SOFA), the worldwide reference system in intensive care drugs used to evaluate the diploma of organ dysfunction in critically sick sufferers, has just lately been printed in JAMA. The replace was additionally introduced in parallel on the Annual Congress of the European Society of Intensive Care Drugs (ESICM LIVES 2025), held in Munich, in a featured session on present subjects broadcast stay.
SOFA-2, which replaces the mannequin in place since 1996, incorporates advances in diagnostics, monitoring, and life assist launched over the previous many years to extra precisely mirror the truth of critically sick sufferers and the response of their organs to remedy.
The research was led by the worldwide SOFA-2 Research Group consortium, with Dr. Otavio Ranzani, head of the Well being DataLab on the Institut de Recerca Sant Pau (IR Sant Pau), serving because the chief of methodology and information evaluation. The magnitude and variety of the information analyzed—greater than 3.3 million ICU admissions from 9 international locations—make this work the biggest worldwide evaluation ever performed on organ dysfunction measurement, setting a brand new benchmark for scientific apply and demanding care analysis.
A brand new customary for measuring the severity of essential sickness
The SOFA system was conceived in 1994 and printed in 1996 as a typical language to explain dysfunction in six organs—mind, coronary heart, lungs, liver, kidneys, and coagulation system—based mostly on scientific and laboratory parameters. Since then, it has grow to be a vital device in each scientific apply and analysis, used to quantify the severity of essential sickness.
Over the previous three many years, intensive care has advanced profoundly. At the moment, clinicians have entry to new monitoring gadgets, much less invasive life-support therapies, and extra particular medication, in addition to info programs that enable for a extra dynamic and exact evaluation of a affected person’s situation. These advances made a whole replace of the unique mannequin crucial.
“The way we treat patients in intensive care has changed enormously over the past three decades,” explains Dr. Ranzani, first writer of the research. “We now have noninvasive ventilation, continuous renal replacement therapies, and circulatory support with much more precise devices and drugs. The SOFA system needed to reflect that reality so we can better describe organ dysfunction and compare patient severity consistently across the world.”
SOFA-2 maintains the construction of six organ programs however redefines the scoring thresholds and updates the variables used. Key improvements embrace the addition of extracorporeal membrane oxygenation (ECMO) and high-flow oxygen remedy within the respiratory part, a brand new classification for vasopressor dosing within the cardiovascular part, and revised standards for assessing liver, kidney, and coagulation perform. The brand new mannequin achieves a extra uniform gradation of severity and a tighter relationship between rating and scientific outcomes.
An unprecedented worldwide scientific consensus
The SOFA replace was performed in eight levels, combining skilled consensus with large-scale scientific information evaluation. First, a Delphi course of introduced collectively 60 worldwide specialists from 25 international locations, together with two from Spain—Dr. Ranzani and Dr. Ricard Ferrer from Vall d’Hebron College Hospital—who reached consensus on the conceptual ideas and key variables of the brand new mannequin. The analysis crew then validated these proposals utilizing superior statistical analyses throughout ten nationwide registries of critically sick sufferers, totaling greater than 3.3 million ICU admissions from Australia, Austria, Brazil, France, Italy, Japan, Nepal, New Zealand, and the USA, thus encompassing numerous well being care programs and useful resource ranges throughout 4 continents.
The result’s a system that preserves the simplicity of the unique SOFA whereas offering a a lot stronger empirical basis and revised scientific standards based mostly on the evaluation of thousands and thousands of real-world circumstances. Every level on the size was calibrated to correspond to a progressive and clinically constant improve in mortality threat, validated throughout totally different cohorts and international locations.
Moreover, detailed directions for information assortment and interpretation have been integrated, guaranteeing uniform software throughout numerous care settings. Altogether, SOFA-2 supplies a extra correct and modern illustration of essential care administration within the twenty first century whereas sustaining the readability and ease of use that characterised the unique mannequin.
“SOFA-2 is the result of an unprecedented scientific consensus in intensive care medicine,” emphasizes Dr. Ranzani. “It integrates the best available evidence with the accumulated clinical experience from highly diverse settings—from high-complexity university hospitals to resource-limited units. This ensures that the tool is truly global.” The outcomes confirmed that SOFA-2 extra precisely describes the development of significant organ perform in critically sick sufferers, displaying a extremely constant relationship between rating and noticed mortality.
Extra exact, sensible, and common
Past its statistical efficiency, the principle contribution of SOFA-2 lies in its larger scientific applicability. The brand new mannequin accounts for the realities of hospitals with various useful resource ranges and defines clear guidelines for information recording and interpretation, decreasing variability between items and international locations.
“We wanted SOFA-2 to be useful both in a large European hospital and in an ICU in a developing country,” notes Dr. Ranzani. “Our goal was to provide a standardized, up-to-date, and global tool to support both research and clinical decision-making.”
The system additionally improves consistency in intermediate ranges of dysfunction, avoiding abrupt jumps between classes and permitting for a extra intuitive gradation of organ deterioration. This enhances its worth for every day scientific monitoring and for evaluating outcomes throughout establishments or therapeutic trials. Furthermore, it contains directions tailored to resource-limited settings, enabling dependable use even in environments the place sure therapies or measurements are unavailable.
A brand new place to begin for intensive care drugs
One other key contribution of SOFA-2 is its capability to harmonize intensive care analysis. By incorporating globally relevant and up to date standards, SOFA-2 facilitates comparability throughout multicenter research and improves the standard of scientific trials. This methodological uniformity is crucial for advancing towards a extra data-driven and internationally legitimate subject of intensive care drugs.
Researchers additionally spotlight its usefulness for monitoring high quality of care in ICUs, because it supplies a delicate and standardized indicator of organ dysfunction amongst handled sufferers. The crew considers this replace a turning level in how essential sickness is quantified, providing a extra exact, dynamic, and practice-aligned framework.
“SOFA-2 is a long-awaited update that enhances intensive care medicine’s ability to measure, understand, and treat critical illness,” concludes Dr. Ranzani. “By more faithfully reflecting patients’ physiology and the interventions they receive, this new system will enable better evaluation of treatment effects and support progress toward more personalized and efficient care.”
Extra info:
Otavio T. Ranzani et al, Improvement and Validation of the Sequential Organ Failure Evaluation (SOFA)-2 Rating, JAMA (2025). DOI: 10.1001/jama.2025.20516
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The worldwide system for assessing organ dysfunction in critically sick sufferers is up to date after thirty years (2025, November 17)
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