Prognostic Utility of the Sequential Organ Failure Assessment (SOFA) Score in Patients with Sepsis Presenting to the Emergency Department: A Prospective Observational Study

Background: Sepsis is a syndrome of life-threatening organ dysfunction caused by a dysregulated host response to infection, and early risk stratification in the emergency department is critical to guiding management, yet the prognostic performance of the Sequential Organ Failure Assessment (SOFA) score in this setting warrants continued local evaluation. The aim is to evaluate the utility of SOFA scoring in assessing the severity of organ dysfunction and predicting outcomes in patients with sepsis presenting to the emergency department (ED). Material and Methods: This single-centre, hospital-based, prospective observational study enrolled 100 adult patients fulfilling Sepsis-3 criteria at a tertiary care emergency department over 12 months. SOFA scores were calculated at admission, 24 hours, and 48 hours, and their association with in-hospital mortality, ICU admission, mechanical ventilation, vasopressor requirement, and length of stay was assessed. Results: The mean SOFA score at admission was 12.4±3.83, declining to 10.8±5.85 by 48 hours (delta SOFA −1.61±3.85). Blood culture positivity was 54%, with Pseudomonas aeruginosa the commonest isolate (25.93%). In-hospital mortality occurred in 15% of patients, ICU admission in 37%, mechanical ventilation in 18%, and vasopressor requirement in 36%. Admission SOFA category was strongly associated with in-hospital mortality (0% in the 0–12 range vs 100% in the 19–24 range, p<0.001), and with vasopressor requirement (p=0.046), mechanical ventilation (p=0.032), length of hospital stay (p=0.042), and ICU stay duration (p<0.001). On comparison of survivors and non-survivors, PaO₂/FiO₂ ratio, platelet count, serum bilirubin, mean arterial pressure, Glasgow Coma Scale, serum creatinine, and SOFA scores at admission, 24 hours, and 48 hours were all significantly different (p<0.05 for all). Conclusion: The SOFA score at admission and its trajectory over the first 48 hours were strongly associated with in-hospital mortality and key clinical outcomes among emergency department patients with sepsis, supporting its use as a practical bedside tool for early risk stratification.

Keywords: Sepsis; SOFA score; Emergency department; Organ dysfunction; Mortality; Sepsis-3.