近日，葡萄牙圣若泽医院Rui Moreno团队研究了序贯器官衰竭评估（SOFA）-2评分的开发和验证。2025年10月29日出版的《美国医学会杂志》发表了这项成果。

重要器官的急性功能障碍是危重疾病的标志。顺序器官衰竭评估（SOFA）评分是最广泛采用的描述器官功能障碍的方法，在30年内没有更新，因此可能无法适当地反映当前的临床实践和结果。

为了通过改进的德尔菲过程（阶段1-5），在专家输入后，在不同的地理和资源设置（阶段6-8）中，告知数据驱动的更新分数（SOFA-2）的组成部分，研究组对2014年至2023年间9个国家（澳大利亚、奥地利、巴西、法国、意大利、日本、尼泊尔、新西兰和美国）1319个重症监护病房（ICU）成年患者的数据进行了联合分析。

包含2098356名患者数据的四个代表性多中心队列用于数据驱动的评分开发和内部验证。对6个队列进行了外部验证，这些队列包含来自1241114名患者的数据。通过改进的德尔菲过程识别器官功能障碍的内容效度应反映在预测效度中，使用第一天ICU时测量的受试者工作特征曲线下面积（AUROC）来衡量评分（分数越高表明器官功能障碍越严重）。

在334万病人中，270108例（8.1%）在ICU死亡（10个队列的范围为4.5%至20.5%）。SOFA-2修改了原SOFA评分的6个器官系统（脑、呼吸、心血管、肝、肾、止血），包括新的变量和修订的阈值，更好地描述器官功能障碍分布，从0到4分及其相关死亡率（SOFA-2 AUROC, 0.79; 95% CI, 0.76-0.81; SOFA-1 AUROC, 0.77; 95% CI, 0.74-0.81）。从ICU第1天到第7天的顺序SOFA-2数据评估保持其预测有效性。数据不足和缺乏内容效度排除了将胃肠道和免疫功能障碍评分纳入SOFA-2。

研究结果表明，SOFA-2评分，更新为包括当代器官支持治疗和新的评分阈值，描述了大量地理和社会经济不同的危重症成年人的器官功能障碍。

附：英文原文

Title: Development and Validation of the Sequential Organ Failure Assessment (SOFA)-2 Score

Author: Otavio T. Ranzani, Mervyn Singer, Jorge I. F. Salluh, Manu Shankar-Hari, David Pilcher, Joana Berger-Estilita, Craig M. Coopersmith, Nicole P. Juffermans, John Laffey, Matti Reinikainen, Ary Serpa Neto, Miguel Tavares, Jean-Franois Timsit, Maria Del Pilar Arias Lopez, Nish Arulkumaran, Diptesh Aryal, Elie Azoulay, Leo Anthony Celi, Dipayan Chaudhuri, Dylan De Lange, Jan De Waele, Claudia C. Dos Santos, Bin Du, Sharon Einav, Teresa Engelbrecht, Fathima Fazla, Ricard Ferrer, Stefano Finazzi, Tomoko Fujii, Hayley B. Gershengorn, John D. Greene, Rashan Haniffa, Sicheng Hao, Mohd Shahnaz Hasan, Steve Hollenberg, Mariachiara Ippolito, Christian Jung, Mikhail Kirov, Shigetaka Kobari, Inès Lakbar, Jeffrey Lipman, Vincent Liu, Xiaoli Liu, Suzana M. Lobo, Demetrio Magatti, Greg S. Martin, Barbara Metnitz, Philipp Metnitz, Sheila N. Myatra, Simon Oczkowski, José-Artur Paiva, Fathima Paruk, Pirkka T. Pekkarinen, Lise Piquilloud, Anssi Plkki, Hallie C. Prescott, Annika Reintam Blaser, Ederlon Rezende, Chiara Robba, Bram Rochwerg, Stephane Ruckly, Rasoul Samei, Edward J. Schenck, Paul Secombe

Issue&Volume: 2025-10-29

Abstract:

Importance  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.

Objectives  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).

Design, Setting, and Participants  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 2098356 patients were used for data-driven score development and internal validation. External validation was performed on 6 cohorts containing data from 1241114 patients.

Main Outcomes and Measures  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).

Results  Of 3.34 million patient encounters, 270108 (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.

Conclusions and Relevance  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.

DOI: 10.1001/jama.2025.20516

Source: https://jamanetwork.com/journals/jama/fullarticle/2840822