  Objective: Sepsis is a life-threatening condition. Sequential Organ Failure
Assessment (SOFA) score is commonly used to assess organ dysfunction and
predict ICU mortality, but it is taken as a static measurement and fails to
capture dynamic changes. This study aims to investigate the relationship
between dynamic changes in SOFA scores over the first 72 hours of ICU admission
and patient outcomes.
  Design, setting, and participants: 3,253 patients in the Medical Information
Mart for Intensive Care IV database who met the sepsis-3 criteria and were
admitted from the emergency department with at least 72 hours of ICU admission
and full-active resuscitation status were analysed. Group-based trajectory
modelling with dynamic time warping and k-means clustering identified distinct
trajectory patterns in dynamic SOFA scores. They were subsequently compared
using Python.
  Main outcome measures: Outcomes including hospital and ICU mortality, length
of stay in hospital and ICU, and readmission during hospital stay, were
collected. Discharge time from ICU to wards and cut-offs at 7-day and 14-day
were taken.
  Results: Four clusters were identified: A (consistently low SOFA scores), B
(rapid increase followed by a decline in SOFA scores), C (higher baseline
scores with gradual improvement), and D (persistently elevated scores). Cluster
D had the longest ICU and hospital stays, highest ICU and hospital mortality.
Discharge rates from ICU were similar for Clusters A and B, while Cluster C had
initially comparable rates but a slower transition to ward.
  Conclusion: Monitoring dynamic changes in SOFA score is valuable for
assessing sepsis severity and treatment responsiveness.
