SOFA ‐2 Score and Mortality in Suspected Infection Stratified by Cirrhosis Status: A Multi‐Institutional Observational Cohort Study

BACKGROUND: Infection is a major cause of mortality in patients with cirrhosis. However, chronic organ dysfunction may confound the interpretation of organ dysfunction scores, and the prognostic value of the updated Sequential Organ Failure Assessment-2 (SOFA-2) score in cirrhotic patients with suspected infection remains unclear. METHODS: We conducted a retrospective multi-institutional cohort study across four hospitals in Taiwan from January 2010 to December 2021. Adult patients admitted from the emergency department (ED) with suspected infection were included and stratified by cirrhosis status. The primary outcome was 28-day mortality. SOFA-2 score distributions, domain-specific patterns and mortality associations were compared between patients with and without cirrhosis. Cox proportional hazards models with site-clustered robust standard errors were used. RESULTS: Among 150 511 patients with suspected infection, 4288 (2.9%) had cirrhosis. Patients with cirrhosis had higher SOFA-2 scores than those without cirrhosis (median, 4 [interquartile range (IQR), 2-6] vs. 2 [IQR, 0-4]; p < 0.001) and higher non-hepatic SOFA-2 scores (median, 3 [IQR, 1-5] vs. 1 [IQR, 0-3]; p < 0.001). The 28-day mortality rate was 14.9% in patients with cirrhosis and 8.9% in those without cirrhosis. After adjustment for age, sex, non-hepatic Charlson Comorbidity Index and non-hepatic SOFA-2 score, cirrhosis remained associated with higher 28-day mortality (adjusted hazard ratio, 1.31; 95% confidence interval, 1.17-1.46; p < 0.001). CONCLUSIONS: Among ED patients with suspected infection, cirrhosis was associated with an increased risk of SOFA-2-defined organ dysfunction and increased mortality. SOFA-2 may support early risk stratification but should be interpreted in the context of cirrhosis-related baseline physiology.