Association of SOFA-2 with in-Hospital Mortality in Refractory Septic Shock: A Multicohort Retrospective Study with a 12-Hour Landmark.
6 affiliations
- 1Department of Intensive Care Unit, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350005, People's Republic of China.
- 2Department 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.
- 3Department of Ultrasound, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350005, People's Republic of China.
- 4Department of Ultrasound, National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350212, People's Republic of China.
- 5Critical Care Medicine, Union Hospital of Fujian Medical University, Fuzhou, Fujian Province, 350001, People's Republic of China.
- 6Department 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.
Abstract
Background
SOFA-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
This 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
The 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
Among 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.
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BibTeX
@article{hu2026association,
title = {{Association of SOFA-2 with in-Hospital Mortality in Refractory Septic Shock: A Multicohort Retrospective Study with a 12-Hour Landmark.}},
author = {Ende Hu and Qian Chen and Wenhui Huang and Jiaxing Ke and Xiaolan Chen},
journal = {Journal of inflammation research},
year = {2026},
month = oct,
doi = {10.2147/jir.s643700},
url = {https://europepmc.org/article/MED/42921198},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Association of SOFA-2 with in-Hospital Mortality in Refractory Septic Shock: A Multicohort Retrospective Study with a 12-Hour Landmark.
AU - Ende Hu
AU - Qian Chen
AU - Wenhui Huang
AU - Jiaxing Ke
AU - Xiaolan Chen
PY - 2026
DA - 2026/10/19
JO - Journal of inflammation research
DO - 10.2147/jir.s643700
UR - https://europepmc.org/article/MED/42921198
AB - Background SOFA-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 This 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 The 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 Among 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.
SN - 1178-7031
ER -