{
  "abstract": "Background\n\nSOFA-2 is an updated organ dysfunction score designed to reflect contemporary intensive care practice. Its clinical relevance in refractory septic shock (RSS) remains unclear. We primarily evaluated the association between SOFA-2 and subsequent in-hospital mortality among patients who were alive and hospitalized at a 12-hour landmark after RSS identification. Comparison with conventional SOFA was secondary and exploratory.Methods\n\nThis retrospective cohort study used MIMIC-IV as the primary cohort, with external consistency analyses in eICU-CRD and a local institutional cohort. RSS was operationalized using available electronic health record variables based on the SCCM/ESICM consensus framework, although some consensus elements were incompletely captured. Patients who died or were discharged before the 12-hour landmark were excluded from the primary analysis. SOFA-2 and conventional SOFA were assessed during the first 12 hours after RSS identification, with follow-up beginning at the landmark. Cause-specific Cox models were used for the primary analysis. Proportional-hazards diagnostics, time-varying coefficient models, time-dependent AUC, restricted cubic spline, subgroup, and sensitivity analyses were also performed.Results\n\nThe primary cohort included 1276 patients, of whom 719 died during hospitalization. In the fully adjusted model, each 1-point increase in SOFA-2 was associated with higher subsequent in-hospital mortality (HR 1.12, 95% CI 1.10-1.14), and the HR per 1-SD increase was 1.54 (95% CI 1.43-1.67). The association attenuated over follow-up but remained positive at 7, 14, and 28 days. Conventional SOFA showed similar per-point associations. Exploratory time-dependent AUC analyses showed only small numerical differences between the two scores. The association was generally consistent across subgroup and sensitivity analyses and directionally consistent in the external cohorts.Conclusion\n\nAmong patients meeting database-operationalized RSS criteria who were alive and hospitalized at the 12-hour landmark, higher SOFA-2 scores were associated with higher subsequent in-hospital mortality.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Intensive Care Unit, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350005, People's Republic of China.",
    "Department of Intensive Care Unit, National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350212, People's Republic of China.",
    "Department of Ultrasound, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350005, People's Republic of China.",
    "Department of Ultrasound, National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350212, People's Republic of China.",
    "Critical Care Medicine, Union Hospital of Fujian Medical University, Fuzhou, Fujian Province, 350001, People's Republic of China.",
    "Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, 350001, People's Republic of China."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Ende Hu"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Qian Chen"
    },
    {
      "affs": [
        4
      ],
      "name": "Wenhui Huang"
    },
    {
      "affs": [
        5
      ],
      "name": "Jiaxing Ke"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Xiaolan Chen",
      "orcid": "0009-0006-5059-1496"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4w8dhx85gvydn.bib",
  "cited_by": 0,
  "doi": "10.2147/jir.s643700",
  "fulltext_url": "https://europepmc.org/articles/PMC13693520",
  "id": "4w8dhx85gvydn",
  "issns": [
    "1178-7031"
  ],
  "landing_url": "https://europepmc.org/article/MED/42921198",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2713|Sepsis Diagnosis and Treatment"
    ]
  ],
  "openalex": "W7222986080",
  "pdf_url": "https://europepmc.org/articles/PMC13693520?pdf=render",
  "pmcid": "PMC13693520",
  "pmid": "42921198",
  "published": "2026-10-19",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/4w8dhx85gvydn.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:33Z",
      "native_id": "MED:42921198",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42921198"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Sepsis Diagnosis and Treatment",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Association of SOFA-2 with in-Hospital Mortality in Refractory Septic Shock: A Multicohort Retrospective Study with a 12-Hour Landmark.",
  "title_text": "Association of SOFA-2 with in-Hospital Mortality in Refractory Septic Shock: A Multicohort Retrospective Study with a 12-Hour Landmark.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:33Z",
  "url": "https://research.draconitic.com/paper/4w8dhx85gvydn",
  "venue": "Journal of inflammation research",
  "versions": []
}