Validation of the new sequential organ failure assessment (SOFA)-2 score in community-acquired pneumonia

Extract Community-acquired pneumonia (CAP) is an acute infectious disease that may be accompanied by organ dysfunction. During the acute episode, the respiratory, renal, cardiovascular/haemodynamic, and neurological systems are most frequently affected. The extent of organ dysfunction correlates closely with prognosis in CAP 1. Early and accurate assessment of the degree of organ involvement is therefore essential to predict outcomes and identify patients at risk of complications. The Sequential Organ Failure Assessment (SOFA) score, developed in 1996, was originally intended to support the management of critically ill patients in the intensive care unit (ICU) 2. Since then, it has been widely adopted. In 2016, the Sepsis-3 consensus defined sepsis as life-threatening organ dysfunction resulting from a dysregulated host response to infection 3, and incorporated the SOFA score into its operational criteria. These criteria have subsequently been validated in patients with CAP 4, 5. More recently, the SOFA score has been updated to SOFA-2, which incorporates contemporary organ-support modalities and revised scoring thresholds 6. However, as acknowledged by its developers, SOFA-2 was derived and validated exclusively in ICU cohorts, and its applicability to patients managed outside the ICU remains uncertain. The aim of the present study, therefore, is to evaluate the performance of the SOFA-2 score in patients admitted to hospital with CAP.