Shigehiko Uchino, Shinshu Katayama
The Sequential Organ Failure Assessment (SOFA) score has become widely adopted for its clinical relevance and simplicity in critical care [ 1 ]. The original SOFA score was designed as an observation-based tool, relying on a limited number of routinely available physiological and laboratory variables. This design facilitated consistent bedside use, large-scale data collection, and automated implementation across clinical settings [ 2 ]. SOFA-2 was developed to reflect contemporary practice while preserving simplicity, usability, widespread applicability, and content validity [ 3 ]. However, several components of SOFA-2 extend beyond directly observable measurements and incorporate treatment-related rules, raising questions about whether SOFA-2 preserves the operational simplicity that enabled widespread adoption of SOFA.