{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:56:41Z","timestamp":1790751401066,"version":"4.1.0"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with sepsis who require vasoactive support during the first 24\u2005h of intensive care represent a heterogeneous population. It is uncertain whether the Sequential Organ Failure Assessment (SOFA)-2 score improves mortality discrimination compared with the SOFA-1 score and whether observed circulatory support intensity provides complementary prognostic information.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicohort observational study used Medical Information Mart for Intensive Care IV (MIMIC-IV) for a 24-h conditional landmark analysis. Patients alive and still in the ICU beyond 24\u2005h were followed from ICU admission +24\u2005h through ICU day 28 for reconstructed all-cause mortality. We compared SOFA-1 and SOFA-2, evaluated SOFA-2 total and cardiovascular scores, analyzed first-24-h five-agent norepinephrine-equivalent peak burden (norepinephrine, epinephrine, dopamine, phenylephrine, and vasopressin), and internally evaluated an exploratory drug-composition model. Fixed strata were assessed directionally in eICU Collaborative Research Database and an independent-center high-risk stress test cohort with cohort-specific endpoints.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The MIMIC-IV 24-h landmark cohort included 11,892 patients and 2,687 post-landmark deaths. SOFA-2 showed no observed discrimination advantage over SOFA-1 (area under the receiver operating characteristic curve, AUROC, 0.731 vs. 0.732; difference, \u22120.0005; 95% confidence interval, \u22120.0086 to 0.0076;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.908). The SOFA-2 cardiovascular score had lower discrimination than the SOFA-1 cardiovascular score (0.663 vs. 0.676;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.006). Mortality was 51.94% for the exploratory SOFA-2 \u226512 group and 17.09% below 12, and increased from 11.30% to 47.45% across four study-defined peak burden categories. The SOFA-2-plus-drug-composition model had an apparent AUROC of 0.768 and a bootstrap-corrected AUROC of 0.767, but it was not externally validated. Fixed strata preserved the direction of risk ranking in both external cohorts, whereas absolute risk and calibration differed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SOFA-2 did not show an observed overall mortality discrimination advantage over SOFA-1 in this population. SOFA-2 total and cardiovascular scores, together with observed vasoactive support intensity, provided complementary prognostic description at 24\u2005h. The \u226512 rule is exploratory, and drug-related associations do not establish causal treatment effects or clinical decision utility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1918792","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:06:34Z","timestamp":1790748394000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic discrimination of SOFA-2 vs. SOFA-1 and incremental information from cardiovascular scoring and vasoactive support intensity in patients with sepsis receiving early vasoactive therapy"],"prefix":"10.3389","volume":"13","author":[{"given":"Tianci","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, The Second Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingyuan","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Wuming Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lifan","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The Second Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The Second Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenglin","family":"Mou","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Wuming Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junyu","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The Second Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","article-title":"Global, regional, and national sepsis incidence and mortality, 1990\u20132017: analysis for the Global Burden of Disease Study","volume":"395","author":"Rudd","year":"2020","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1276","DOI":"10.1016\/S0140-6736(25)02422-5","article-title":"Sepsis","volume":"407","author":"Singer","year":"2026","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1007\/s00134-026-08361-1","article-title":"Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2026","volume":"52","author":"Prescott","year":"2026","journal-title":"Intensive Care Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021","volume":"47","author":"Evans","year":"2021","journal-title":"Intensive Care Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2090","DOI":"10.1001\/jama.2025.20516","article-title":"Development and validation of the Sequential Organ Failure Assessment (SOFA)-2 score","volume":"334","author":"Ranzani","year":"2025","journal-title":"JAMA"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e2545040","DOI":"10.1001\/jamanetworkopen.2025.45040","article-title":"Rationale and methodological approach underlying the development of the sequential organ failure assessment (SOFA)\u20132 score","volume":"8","author":"Moreno","year":"2025","journal-title":"JAMA Netw Open"},{"key":"B7","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1186\/s40560-026-00875-6","article-title":"SOFA-2 versus SOFA-1 for mortality prediction in critically ill patients","volume":"14","author":"Bai","year":"2026","journal-title":"J Intensive Care"},{"key":"B8","doi-asserted-by":"publisher","first-page":"100601","DOI":"10.1016\/j.clinme.2026.100601","article-title":"Comparative prognostic performance of SOFA-1 and SOFA-2 in patients with sepsis at ICU admission","volume":"26","author":"Lin","year":"2026","journal-title":"Clin Med (Lond)"},{"key":"B9","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1186\/s13054-026-06093-8","article-title":"Predictive validity of daily sequential organ failure assessment (SOFA)-2 score for 30-day mortality","volume":"30","author":"Helleberg","year":"2026","journal-title":"Crit Care"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1216","DOI":"10.1016\/j.chest.2023.07.009","article-title":"Optimizing vasopressin use and initiation timing in septic shock","volume":"164","author":"Sacha","year":"2023","journal-title":"Chest"},{"key":"B11","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1007\/s00134-025-08211-6","article-title":"Current standard of care for septic shock","volume":"52","author":"Delaney","year":"2026","journal-title":"Intensive Care Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1186\/s13054-022-04255-y","article-title":"A plea for personalization of the hemodynamic management of septic shock","volume":"26","author":"De Backer","year":"2022","journal-title":"Crit Care"},{"key":"B13","volume-title":"MIMIC-IV (version 3.1)","author":"Johnson","year":"2024"},{"key":"B14","volume-title":"eICU Collaborative Research Database (version 2.0)","author":"Pollard","year":"2019"},{"key":"B15","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1093\/jamia\/ocx084","article-title":"The MIMIC code repository: enabling reproducibility in critical care research","volume":"25","author":"Johnson","year":"2018","journal-title":"J Am Med Inform Assoc"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"Von Elm","year":"2007","journal-title":"Lancet"},{"key":"B17","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for sepsis and septic shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"B18","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1007\/BF01709751","article-title":"The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction\/failure","volume":"22","author":"Vincent","year":"1996","journal-title":"Intensive Care Med"},{"key":"B19","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1016\/j.jcrc.2020.11.002","article-title":"Vasopressor dose equivalence: a scoping review and suggested formula","volume":"61","author":"Goradia","year":"2021","journal-title":"J Crit Care"},{"key":"B20","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s13054-023-04322-y","article-title":"An updated \u201cnorepinephrine equivalent\u201d score in intensive care as a marker of shock severity","volume":"27","author":"Kotani","year":"2023","journal-title":"Crit Care"},{"key":"B21","doi-asserted-by":"publisher","first-page":"837","DOI":"10.2307\/2531595","article-title":"Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach","volume":"44","author":"DeLong","year":"1988","journal-title":"Biometrics"},{"key":"B22","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1177\/0272989X06295361","article-title":"Decision curve analysis: a novel method for evaluating prediction models","volume":"26","author":"Vickers","year":"2006","journal-title":"Med Decis Making"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1643","DOI":"10.1016\/j.spinee.2021.02.024","article-title":"Decision curve analysis to evaluate the clinical benefit of prediction models","volume":"21","author":"Vickers","year":"2021","journal-title":"Spine J"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1415769","DOI":"10.3389\/fcvm.2024.1415769","article-title":"Prognostic evaluation of the norepinephrine equivalent score and the vasoactive-inotropic score in patients with sepsis and septic shock: a retrospective cohort study","volume":"11","author":"Li","year":"2024","journal-title":"Front Cardiovasc Med"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1918792\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:06:35Z","timestamp":1790748395000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1918792\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":24,"alternative-id":["10.3389\/fcvm.2026.1918792"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1918792","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"article-number":"1918792"}}