{
  "abstract": "Background: Patients with sepsis who require vasoactive support during the first 24 h 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.\n\nMethods: 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 h were followed from ICU admission +24 h 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.\n\nResults: 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, −0.0005; 95% confidence interval, −0.0086 to 0.0076; P = 0.908). The SOFA-2 cardiovascular score had lower discrimination than the SOFA-1 cardiovascular score (0.663 vs. 0.676; P = 0.006). Mortality was 51.94% for the exploratory SOFA-2 ≥12 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\nConclusion: 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 h. The ≥12 rule is exploratory, and drug-related associations do not establish causal treatment effects or clinical decision utility.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Critical Care Medicine, The Second Affiliated Hospital of Guangxi Medical University , , ,",
    "Department of Emergency Medicine, Wuming Hospital of Guangxi Medical University , , ,",
    "Department of Critical Care Medicine, Wuming Hospital of Guangxi Medical University , , ,"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Tianci Huang"
    },
    {
      "affs": [
        1
      ],
      "name": "Mingyuan Pan"
    },
    {
      "affs": [
        0
      ],
      "name": "Lifan Pan"
    },
    {
      "affs": [
        0
      ],
      "name": "Peng Liang"
    },
    {
      "affs": [
        2
      ],
      "name": "Chenglin Mou"
    },
    {
      "affs": [
        0
      ],
      "name": "Junyu Lu"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4ebtwgycsvwbf.bib",
  "cited_by": 0,
  "doi": "10.3389/fcvm.2026.1918792",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661955/?tool=EBI",
  "id": "4ebtwgycsvwbf",
  "issns": [
    "2297-055X"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13661955",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2713|Sepsis Diagnosis and Treatment"
    ]
  ],
  "openalex": "W7214907981",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661955/pdf/?tool=EBI",
  "pmcid": "PMC13661955",
  "pmid": null,
  "published": "2026-09-30",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/4ebtwgycsvwbf.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:20Z",
      "native_id": "PMC:PMC13661955",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13661955"
    },
    {
      "first_seen": "2026-10-30T12:20:10Z",
      "native_id": "10.3389/fcvm.2026.1918792",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fcvm.2026.1918792/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Sepsis Diagnosis and Treatment",
      "subfield": "epidemiology-public-health"
    }
  ],
  "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",
  "title_text": "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",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:10Z",
  "url": "https://research.draconitic.com/paper/4ebtwgycsvwbf",
  "venue": "Frontiers in cardiovascular medicine",
  "versions": []
}