Calculadora interativa baseada em Ranzani et al. (JAMA, 2025)
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Mortalidade aproximada: —
*Estimativas aproximadas derivadas das curvas metanalíticas do artigo (Ranzani et al., JAMA 2025) e do gradiente logístico (OR = 1.378 por ponto).
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Acute dysfunction of vital organs is the hallmark of critical illness. The Sequential Organ Failure Assessment (SOFA) score, the most widely adopted approach to describe organ dysfunction, has not been updated in 30 years and therefore may not appropriately capture current clinical practice and outcomes.
Acute dysfunction of vital organs is the hallmark of critical illness. The SOFA score has not been updated in 30 years and may not capture current practice and outcomes.
To inform the data-driven component of an updated score (SOFA-2) in varied geographical and resource settings (stages 6-8) after expert input via a modified Delphi process (stages 1-5).
A federated analysis was performed on data collected from adult patients admitted to 1319 ICUs in 9 countries between 2014 and 2023. Four multicenter cohorts with data from 2,098,356 patients were used for development and internal validation; external validation used 6 cohorts with 1,241,114 patients.
Content validity identified through the modified Delphi process should be reflected by predictive validity using AUROC of the score measured on the first ICU day.
Of 3.34 million patient encounters, 270,108 (8.1%) died in ICU. SOFA-2 modified the 6 organ systems of the original SOFA, including new variables and revised thresholds that better describe organ dysfunction from 0 to 4 points and associated mortality (SOFA-2 AUROC, 0.79; 95% CI, 0.76-0.81; SOFA-1 AUROC, 0.77; 95% CI, 0.74-0.81). Sequential SOFA-2 from ICU day 1 to day 7 maintained predictive validity. Insufficient data and lack of content validity precluded gastrointestinal and immune dysfunction components.
The SOFA-2 score, updated to include contemporary organ support treatments and new thresholds, describes organ dysfunction in a large, geographically and socioeconomically diverse population of critically ill adults.
For sedated patients, use the last recorded GCS before sedation. If the previous GCS is unknown, score 0.
When not possible to evaluate the 3 domains of GCS, use the best achieved score in the motor-scale domain.
If receiving drug treatment for delirium (short- or long-term), score 1 point even if GCS is 15. For relevant drugs, see International PADIS Guidelines.
Use arterial oxygen saturation (SpO₂) to FiO₂ ratio only when PaO₂:FiO₂ ratio is unavailable and where SpO₂ is less than 98.
Ventilatory support is defined as receipt of high-flow nasal cannula, continuous positive airflow pressure, bilevel positive airway pressure, noninvasive ventilation, invasive mechanical ventilation, or long-term home ventilation.
Patients not receiving advanced respiratory support can score a maximum 2 points unless ventilatory support is not available or precluded due to the ceiling of treatment.
ECMO (all forms) is scored 4 in respiratory domain regardless of PaO₂:FiO₂ ratio. In cardiovascular domain score 4 points for use of veno-arterial ECMO only.
Vasopressor medication is only scored if given by continuous intravenous infusion for at least 1 hour.
Noradrenaline is usually dispensed as the salt (eg, hemitartrate or bitartrate). Dose should be expressed as the base. One mg of norepinephrine base is equivalent to 2 mg of norepinephrine bitartrate monohydrate.
If dopamine is used as a single vasopressor, scoring is based on the following cutoffs: 2 points, 20 or less μg/kg/min; 3 points, more than 20 to 40 or less μg/kg/min; and 4 points, more than 40 μg/kg/min.
Where vasoactive drugs are unavailable or precluded due to a ceiling of treatment, use the following MAP cut-offs for scoring: 0 points, 70 mm Hg or greater; 1 point, 60 to 69 mm Hg; 2 points, 50 to 59 mm Hg; 3 points, 40 to 49 mm Hg; and 4 points less than 40 mm Hg.
Excludes patients receiving RRT exclusively for nonrenal causes (eg, removal of toxic products, bacterial toxins, cytokines).
For patients not receiving RRT (eg, ceiling of treatment, machine unavailability, or decision to delay commencement), score 4 points if they otherwise meet criteria for RRT, ie, creatinine level greater than 1.2 mg/dL (>110 μmol/L) or oliguria (<0.3 mL/kg/h) for more than 6 hours plus at least 1 of either serum potassium of 6.0 mmol/L or greater or metabolic acidosis with pH of 7.20 or less and serum bicarbonate of 12 mmol/L or less.
For patients receiving intermittent RRT, score 4 points on days not receiving RRT until RRT use is terminated.
Disclaimer — This calculator is provided for educational and research purposes only. It should not be used as a sole tool for diagnosis or clinical decision-making. By using this application, you acknowledge that you understand these terms and accept full responsibility for its use. Based on: Ranzani OT et al., JAMA 2025. SOFA-2 Research Group.