{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T04:49:06Z","timestamp":1793508546526,"version":"4.5.0"},"reference-count":48,"publisher":"American Medical Association (AMA)","issue":"23","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2025,12,16]]},"abstract":"\n Importance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n 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).<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n A federated analysis was performed on data collected from adult patients admitted to 1319 intensive care units (ICUs) in 9 countries (Australia, Austria, Brazil, France, Italy, Japan, Nepal, New Zealand, United States) between 2014 and 2023. Four representative multicenter cohorts containing data from 2\u202f098\u202f356 patients were used for data-driven score development and internal validation. External validation was performed on 6 cohorts containing data from 1\u202f241\u202f114 patients.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Content validity for organ dysfunction identified through the modified Delphi process should be reflected by predictive validity using the area under the receiver operating characteristic (AUROC) curve of the score measured on the first ICU day (higher scores indicate worse organ dysfunction).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 3.34 million patient encounters, 270\u202f108 (8.1%) died in the ICU (range, 4.5% to 20.5% across the 10 cohorts). SOFA-2 modified the 6 organ systems of the original SOFA score (brain, respiratory, cardiovascular, liver, kidney, hemostasis), including new variables and revised thresholds that better describe the organ dysfunction distribution from 0 to 4 points and their associated mortality (SOFA-2 AUROC, 0.79; 95% CI, 0.76-0.81; SOFA-1 AUROC, 0.77; 95% CI, 0.74-0.81). Evaluation of sequential SOFA-2 data from ICU day 1 to day 7 maintained its predictive validity. Insufficient data and lack of content validity precluded incorporation of gastrointestinal and immune dysfunction scores into SOFA-2.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n The SOFA-2 score, updated to include contemporary organ support treatments and new score thresholds, describes organ dysfunction in a large, geographically and socioeconomically diverse population of critically ill adults.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2025.20516","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T13:30:54Z","timestamp":1761744654000},"page":"2090","source":"Crossref","is-referenced-by-count":177,"title":["Development and Validation of the Sequential Organ Failure Assessment (SOFA)-2 Score"],"prefix":"10.1001","volume":"334","author":[{"given":"Otavio T.","family":"Ranzani","sequence":"first","affiliation":[{"name":"DataHealth Lab, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain"},{"name":"ISGlobal, Barcelona, Spain"},{"name":"Pulmonary Division, Faculty of Medicine, Heart Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mervyn","family":"Singer","sequence":"additional","affiliation":[{"name":"Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge I. F.","family":"Salluh","sequence":"additional","affiliation":[{"name":"Postgraduate Program, Instituto D\u2019Or de Pesquisa e Ensino Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manu","family":"Shankar-Hari","sequence":"additional","affiliation":[{"name":"Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, Scotland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Pilcher","sequence":"additional","affiliation":[{"name":"The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcomes and Resources Evaluation, Australian"},{"name":"Department of Intensive Care, Alfred Health, Prahran, Victoria, Australia"},{"name":"New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joana","family":"Berger-Estilita","sequence":"additional","affiliation":[{"name":"Institute for Medical Education, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig M.","family":"Coopersmith","sequence":"additional","affiliation":[{"name":"Department of Surgery and Emory Critical Care Center, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole P.","family":"Juffermans","sequence":"additional","affiliation":[{"name":"Department of Intensive Care and Laboratory of Translational Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Laffey","sequence":"additional","affiliation":[{"name":"Anaesthesia and Intensive Care Medicine, School of Medicine, University of Galway, Ireland"},{"name":"Department of Anaesthesia, Galway University Hospitals, Galway, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matti","family":"Reinikainen","sequence":"additional","affiliation":[{"name":"University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ary Serpa","family":"Neto","sequence":"additional","affiliation":[{"name":"The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcomes and Resources Evaluation, Australian"},{"name":"Department of Intensive Care, Austin Hospital, Melbourne, Australia"},{"name":"Department of Critical Care Medicine, Hospital Israelita Albert Einstein, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Tavares","sequence":"additional","affiliation":[{"name":"Unidade Local de Sa\u00fade Santo Ant\u00f3nio, Porto, Portugal"},{"name":"ICBAS-Instituto de Ci\u00eancias Biom\u00e9dicas Abel Salazar, Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Fran\u00e7ois","family":"Timsit","sequence":"additional","affiliation":[{"name":"IAME (Infection Antimicrobials Modelling Evolution), UMR 1137, University Paris-Cit\u00e9, Paris, France"},{"name":"Medical and Infectious Diseases Intensive Care Unit, APHP, H\u00f4pital Bichat-Claude Bernard, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Del Pilar","family":"Arias Lopez","sequence":"additional","affiliation":[{"name":"Management, Quality and Data Committee, SATI-Q Program, Argentine Society of Intensive Care (SATI), Buenos Aires, Argentina"},{"name":"PICU, Hospital de Ni\u00f1os Ricardo Gutierrez, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nish","family":"Arulkumaran","sequence":"additional","affiliation":[{"name":"Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diptesh","family":"Aryal","sequence":"additional","affiliation":[{"name":"Postgraduate Program, Instituto D\u2019Or de Pesquisa e Ensino Rio de Janeiro, Brazil"},{"name":"Nepal Intensive Care Research Foundation, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elie","family":"Azoulay","sequence":"additional","affiliation":[{"name":"APHP, Paris City University, Saint-Louis Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leo Anthony","family":"Celi","sequence":"additional","affiliation":[{"name":"Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, Massachusetts"},{"name":"Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts"},{"name":"Department of Biostatistics, Harvard T.H. 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