- qSOFA — a rapid bedside screen. Tick each of the three criteria the patient meets: respiratory rate ≥ 22/min, altered mentation (GCS < 15), and systolic BP ≤ 100 mmHg. The score (0–3) updates live.
- SOFA — the full six-organ score. For each organ system, select the band that matches the worst value in the assessment window.
- For the renal sub-score, set the creatinine unit (mg/dL ↔ µmol/L) to match your lab, then choose the band — or use urine output if creatinine is unavailable.
- The result cards show qSOFA (/3) and SOFA total (/24) with an interpretation and recommended action.
- Sepsis (Sepsis-3) = suspected infection plus an acute rise in SOFA ≥ 2 from baseline. Baseline SOFA is assumed 0 in patients without known prior organ dysfunction — for CKD or cirrhosis, interpret the change, not the absolute score.
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When to Use
The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3, 2016) redefined sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection. qSOFA (quick SOFA) is a fast, three-item bedside prompt to identify patients with suspected infection who are at higher risk of a poor outcome; the full SOFA score quantifies organ dysfunction across six systems and operationalises the sepsis definition.
Appropriate use
Use qSOFA in patients with suspected infection outside the ICU to flag those who warrant closer assessment for sepsis and possible escalation. Use SOFA wherever the data are available (laboratory + monitoring) to grade organ dysfunction and to define sepsis as an acute rise in SOFA ≥ 2 with suspected infection. SOFA is also a validated mortality-risk descriptor in critically ill patients.
What these scores are not
Sepsis-3 deprecated SIRS for screening, but neither qSOFA nor SOFA is a diagnosis of sepsis — they flag risk and quantify organ dysfunction. qSOFA has limited sensitivity as a sole screen and should not be used to rule out sepsis. A high SOFA in a patient with chronic organ dysfunction (CKD, cirrhosis) may reflect baseline disease, not acute deterioration — what matters is the acute change.
Pearls & Pitfalls
qSOFA ≥ 2 should prompt action
Two or more qSOFA points in a patient with suspected infection identifies higher risk of in-hospital mortality and prolonged ICU stay. Treat it as a trigger to evaluate formally for sepsis: measure lactate, draw cultures, consider antibiotics, and escalate the level of monitoring or care.
Interpret the SOFA delta, not the absolute
Sepsis is defined by an acute increase in SOFA ≥ 2 in the setting of suspected infection — which reflects roughly a 10% in-hospital mortality. Baseline SOFA is assumed 0 unless the patient has known prior organ dysfunction. In CKD the renal sub-score is elevated at baseline and in cirrhosis the liver sub-score is elevated — so always anchor against a known or estimated baseline before calling the score "septic."
Pitfalls
(1) Do not use qSOFA to exclude sepsis — its sensitivity is limited as a single screen. (2) The PaO₂/FiO₂ bands of 3 and 4 require respiratory support (ventilation/CPAP). (3) Vasopressor doses are in µg/kg/min and assume administration for ≥ 1 hour. (4) Baseline organ dysfunction inflates SOFA — interpret the change. (5) These scores support, not replace, clinical judgment.
Why Use It
Standardised, reproducible scoring brings consistency to a high-stakes, time-critical decision. qSOFA needs no labs and can be calculated in seconds at the bedside, giving every clinician a shared trigger for escalation. The full SOFA score operationalises the Sepsis-3 definition so that "sepsis" carries the same meaning across teams and shifts, and supplies a calibrated mortality-risk descriptor. For nephrology and complex-comorbidity patients in particular, an explicit baseline-versus-current comparison prevents both over-calling chronic dysfunction as sepsis and under-recognising true acute deterioration.
qSOFA & SOFA Score Calculator (Sepsis-3)
Score the rapid bedside qSOFA and the full six-organ SOFA. Both update live. qSOFA ≥ 2 flags higher risk; an acute rise in SOFA ≥ 2 with suspected infection defines sepsis.
1 · qSOFA — bedside screen (0–3)
2 · SOFA — six organ systems (0–24)
⚕ qSOFA = 1 point each for RR ≥ 22/min, altered mentation (GCS < 15), and SBP ≤ 100 mmHg (qSOFA ≥ 2 = higher risk). SOFA = sum of six organ sub-scores (respiration, coagulation, liver, cardiovascular, CNS, renal), each 0–4, total 0–24. Sepsis (Sepsis-3) = suspected infection + acute rise in SOFA ≥ 2 from baseline; baseline is assumed 0 without known prior organ dysfunction. Creatinine SI: µmol/L = mg/dL × 88.4. These scores support, not replace, clinical judgment. Source: Singer M, et al. JAMA. 2016;315(8):801–810; Vincent JL, et al. Intensive Care Med. 1996;22:707–710.
Next Steps
Use the scores to support — not replace — clinical judgment.
- qSOFA ≥ 2 with suspected infection: escalate assessment — measure serum lactate, draw blood cultures before antibiotics, and evaluate formally for sepsis.
- Acute rise in SOFA ≥ 2 + infection = sepsis: initiate the Surviving Sepsis hour-1 bundle — lactate, cultures, broad-spectrum antibiotics, fluid resuscitation, and vasopressors to keep MAP ≥ 65 mmHg if hypotensive; consider ICU.
- Re-measure lactate if the initial value is > 2 mmol/L and reassess the SOFA components serially to track the trajectory.
- For CKD, cirrhosis, or other chronic organ dysfunction, anchor the score against the patient's baseline and interpret the change, not the absolute number.
- Escalate to critical care for shock, rising SOFA, or any clinical deterioration regardless of the calculated score.
Evidence & References
qSOFA criteria (1 point each; range 0–3)
| Criterion | Threshold |
|---|---|
| Respiratory rate | ≥ 22 breaths/min |
| Altered mentation | Glasgow Coma Scale < 15 |
| Systolic blood pressure | ≤ 100 mmHg |
qSOFA ≥ 2 in suspected infection identifies higher risk of in-hospital mortality and prolonged ICU stay outside the ICU. It is a prompt to evaluate for sepsis and escalate — not a diagnosis, and not a rule-out test.
SOFA sub-scores (each 0–4; total 0–24)
| System | 0 | 1 | 2 | 3 | 4 |
|---|---|---|---|---|---|
| Respiration — PaO₂/FiO₂ (mmHg) | ≥ 400 | < 400 | < 300 | < 200* | < 100* |
| Coagulation — Platelets (×10³/µL) | ≥ 150 | < 150 | < 100 | < 50 | < 20 |
| Liver — Bilirubin (mg/dL) | < 1.2 | 1.2–1.9 | 2.0–5.9 | 6.0–11.9 | > 12.0 |
| Cardiovascular (µg/kg/min) | MAP ≥ 70 | MAP < 70 | Dop ≤ 5 or dobut | Dop > 5 or NE/E ≤ 0.1 | Dop > 15 or NE/E > 0.1 |
| CNS — Glasgow Coma Scale | 15 | 13–14 | 10–12 | 6–9 | < 6 |
| Renal — Creatinine (mg/dL) / UO | < 1.2 | 1.2–1.9 | 2.0–3.4 | 3.5–4.9 / UO < 500 | > 5.0 / UO < 200 |
* Bands 3 and 4 for respiration require respiratory support (mechanical ventilation/CPAP). Dop = dopamine, NE = norepinephrine, E = epinephrine, dobut = dobutamine; vasopressor doses are µg/kg/min for ≥ 1 hour. UO = urine output in mL/day. Creatinine SI conversion: µmol/L = mg/dL × 88.4.
Defining sepsis (Sepsis-3)
Sepsis is suspected or documented infection plus an acute change in total SOFA ≥ 2 points from baseline — which reflects an in-hospital mortality of roughly 10%. Baseline SOFA is assumed to be 0 in patients not known to have pre-existing organ dysfunction. Septic shock is sepsis with persisting hypotension requiring vasopressors to maintain MAP ≥ 65 mmHg and a serum lactate > 2 mmol/L despite adequate volume resuscitation. In CKD or cirrhosis the renal or liver sub-score is elevated at baseline, so interpret the acute delta rather than the absolute SOFA.
References
- Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801–810.
- Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med. 1996;22(7):707–710.
- Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis (qSOFA validation). JAMA. 2016;315(8):762–774.
- Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med. 2021;49(11):e1063–e1143.
