LAUSR

The article published by Pölkki and colleagues asks a timely and relevant question: Can we use the Sequential Organ Failure Assessment (SOFA) as an endpoint in clinical trials?1 The authors tested the validity of the maximum daily SOFA score measured within the first 24 h after admission to the intensive care unit (ICU) as a surrogate outcome for inhospital mortality using registry data from over 60,000 patients admitted to 26 Finnish intensive care units. Based on their analyses, the short answer to the question is no, and the conclusion is that the SOFA needs an update. Beyond setting the stage for a necessary update of the SOFA score, we will challenge misconceptions that have arisen around its use over the years.