Chart — Critical Care
SOFA Score Chart
Sequential Organ Failure Assessment — all 6 organ systems × 5 score levels (0–4), Sepsis-3 definitions, total score mortality correlation, qSOFA rapid bedside tool, and nursing application.
Educational use only. SOFA scoring is a clinical assessment tool. Apply with full clinical context. Individual mortality estimates are population-based — not applicable to individual patients. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Sepsis-3 Definitions
| Sepsis | Suspected/confirmed infection + acute SOFA increase ≥ 2 from baseline = organ dysfunction. Baseline SOFA = 0 for patients without prior organ dysfunction. |
| Septic shock | Sepsis + vasopressor requirement (to maintain MAP ≥ 65 mmHg) + serum lactate > 2 mmol/L despite adequate volume resuscitation. Hospital mortality > 40%. |
| SIRS (historical) | ≥ 2 of: fever/hypothermia, tachycardia, tachypnea, WBC change. Replaced by SOFA-based Sepsis-3 (2016). Still on NCLEX — know both old and new definitions. |
SOFA Scoring — 6 Organ Systems (Scores 0–4)
| Organ System | Parameter | Score 0 | Score 1 | Score 2 | Score 3 | Score 4 |
|---|---|---|---|---|---|---|
| Respiratory | PaO₂/FiO₂ (mmHg) | ≥ 400 | 300–399 | 200–299 | 100–199 + respiratory support | < 100 + respiratory support |
| Coagulation | Platelets (×10³/µL) | ≥ 150 | 100–149 | 50–99 | 20–49 | < 20 |
| Liver | Bilirubin (mg/dL) | < 1.2 | 1.2–1.9 | 2.0–5.9 | 6.0–11.9 | ≥ 12.0 |
| Cardiovascular | MAP or vasopressor dose | MAP ≥ 70 mmHg | MAP < 70 (no vasopressors) | Dopamine < 5 OR dobutamine (any dose) | Dopa 5.1–15 OR Epi ≤ 0.1 OR Norepi ≤ 0.1 (µg/kg/min) | Dopa > 15 OR Epi > 0.1 OR Norepi > 0.1 (µg/kg/min) |
| CNS | Glasgow Coma Scale (GCS) | 15 | 13–14 | 10–12 | 6–9 | < 6 |
| Renal | Creatinine (mg/dL) OR urine output | Cr < 1.2 | Cr 1.2–1.9 | Cr 2.0–3.4 | Cr 3.5–4.9 OR UO < 500 mL/day | Cr ≥ 5.0 OR UO < 200 mL/day |
Respiratory Pearl
Normal = 400–500 mmHg on room air. Calculate: PaO₂ (from ABG) ÷ FiO₂ (as decimal: room air = 0.21, 40% O₂ = 0.40). PaO₂/FiO₂ < 300 = mild ARDS; < 200 = moderate; < 100 = severe.
Coagulation Pearl
Platelet consumption in sepsis = DIC, endothelial damage, bone marrow suppression. Platelet score 3–4 = significant coagulopathy. Watch for petechiae, bleeding, prolonged PT/PTT.
Liver Pearl
Sepsis-associated liver failure: biliary stasis + hypoperfusion + direct hepatocyte injury. Jaundice (bilirubin > 3 = visible) is a late sign. Score 4 = acute liver failure pattern.
Cardiovascular Pearl
Score ≥ 2 = vasopressor requirement = Septic shock cardiovascular criterion. Record exact vasopressor doses (µg/kg/min). Multiple vasopressors = higher scores. Norepinephrine is first-line for septic shock.
CNS Pearl
Consider sedation effect when scoring GCS in mechanically ventilated patients. A sedated patient cannot be reliably scored — note in documentation. GCS < 15 is also one of 3 qSOFA criteria.
Renal Pearl
Urine output criterion enables bedside scoring when creatinine unavailable (e.g., early shift). UO < 500 mL/24h ≈ UO < 21 mL/hr. Sepsis AKI: typically prerenal initially → ATN with prolonged hypoperfusion.
Total SOFA Score Interpretation
| Total SOFA Score | Approx. ICU Mortality | Clinical Context |
|---|---|---|
| 0–1 | < 10% | Normal or near-normal. Low mortality risk. |
| 2–3 | 10–20% | Organ dysfunction present. Sepsis-3 criteria met with ≥ 2 increase from baseline. |
| 4–5 | 20–30% | Multi-system involvement. ICU-level care required. |
| 6–9 | 30–50% | Significant multi-organ dysfunction syndrome (MODS). |
| 10–14 | 50–80% | Severe MODS. Consider goals-of-care discussion. |
| ≥ 15 | > 80% | Critical MODS with extremely high mortality. |
Mortality estimates are population-based approximations from the original SOFA validation studies. Individual patient outcomes vary with comorbidities, treatment, and institutional factors.
qSOFA — Rapid Bedside Screening
Use qSOFA OUTSIDE the ICU (ED, medical floor, step-down) — requires no labs. Score ≥ 2 = prompt full sepsis workup.
| Criterion | Threshold | Score |
|---|---|---|
| Altered mental status | GCS < 15 (new confusion, agitation, decreased LOC) | +1 |
| Respiratory rate | RR ≥ 22 breaths/min | +1 |
| Systolic blood pressure | SBP ≤ 100 mmHg | +1 |
qSOFA ≥ 2 of 3: Prompt comprehensive sepsis evaluation — blood cultures × 2 before antibiotics, lactate, CBC, CMP, CXR. Notify provider. qSOFA is a SCREENING tool only — a negative score does NOT rule out sepsis.
NCLEX Pearls
Sepsis-3 sepsis = infection + SOFA ≥ 2 from baseline. Not just fever/tachycardia (SIRS) — requires evidence of organ dysfunction.
Septic shock = sepsis + vasopressors (MAP ≥ 65) + lactate > 2 despite adequate fluids. Hospital mortality > 40%.
qSOFA: altered mental status + RR ≥ 22 + SBP ≤ 100. ≥ 2 = workup. No labs needed — pure bedside tool.
Cardiovascular SOFA: Score 2 = dobutamine (any dose) — dobutamine alone indicates cardiac compromise requiring pharmacological support.
Norepinephrine (Norepi) = first-line vasopressor for septic shock. Dopamine has more arrhythmias (SOAP II trial).
Renal SOFA: UO criterion usable when creatinine not yet available — UO < 500 mL/24h = score 3.
SIRS criteria still appear on NCLEX — know historical (2+ of fever/hypothermia, tachycardia, tachypnea, WBC abnormality) even though Sepsis-3 superseded them in practice.
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with Society of Critical Care Medicine (SCCM) · Surviving Sepsis Campaign · American Association of Critical-Care Nurses (AACN). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →