URGENT UPDATE: The global standard for assessing organ dysfunction in critically ill patients has been revolutionized with the release of the SOFA-2 score, announced today, September 30, 2025, in JAMA and presented at the ESICM LIVES 2025 conference in Munich. This groundbreaking update, the first in nearly three decades, aims to enhance the accuracy of organ dysfunction assessments, a crucial tool in intensive care medicine.
The new SOFA-2 model replaces the original framework established in 1996 and reflects significant advancements in medical technology and patient care over the years. It draws on an unprecedented analysis of over 3.3 million ICU admissions across nine countries, making it the largest international review of organ dysfunction measurement to date. This comprehensive data provides a solid foundation for clinical practice and critical care research moving forward.
The SOFA system, which was introduced to standardize the evaluation of organ dysfunction across six key systems—brain, heart, lungs, liver, kidneys, and coagulation—has been updated to incorporate new diagnostic tools and treatment modalities. Key innovations in SOFA-2 include the integration of extracorporeal membrane oxygenation (ECMO) and high-flow oxygen therapy, as well as refined criteria for assessing liver, kidney, and coagulation functions.
Dr. Otavio Ranzani, who led the methodology and data analysis team for the SOFA-2 update, emphasized the importance of this development: “The way we treat patients in intensive care has changed enormously over the past three decades. The SOFA system needed to reflect that reality so we can better describe organ dysfunction and compare patient severity consistently across the world.”
The update process involved an extensive Delphi consensus among 60 experts from 25 countries, ensuring that the new model is applicable in diverse healthcare settings, from high-complexity hospitals to resource-limited environments. This global collaboration underscores a unified approach to critical care, providing a tool that is both practical and universally applicable.
SOFA-2 maintains the original structure while re-defining scoring thresholds and updating variables, which ensures a more consistent relationship between the score and clinical outcomes. Each point on the scale now corresponds to a clear increase in mortality risk, validated by data across various cohorts worldwide.
“This is a long-awaited update that enhances intensive care medicine’s ability to measure, understand, and treat critical illness,” Dr. Ranzani stated. The new model’s capacity to harmonize research and facilitate comparison across multicenter studies is crucial for advancing data-driven practices in intensive care.
The implications of SOFA-2 are particularly significant as they promise to improve patient monitoring and care quality. By providing clear, standardized criteria for assessing organ dysfunction, healthcare providers can make more informed decisions, ultimately leading to better outcomes for critically ill patients.
As the medical community reacts to these profound changes, SOFA-2 sets a new benchmark for assessing critical illness in the 21st century. The update not only enhances the precision of existing practices but also paves the way for future advancements in intensive care medicine.
Stay tuned for more updates on this pivotal change in critical care assessment, which aims to provide a more effective and unified approach to patient management globally.
