Background Patients with Coronavirus disease 2019 (COVID-19) have a high mortality rate, and thus, it is particularly important to predict the severity and prognosis of COVID-19. The Sequential Organ Failure Assessment (SOFA) score has been used to predict the clinical outcomes of patients with multiple organ failure requiring intensive care. Therefore, we retrospectively analyzed the clinical characteristics, risk factors, and relationship between the SOFA score and the prognosis of COVID-19 patients. Methods Clinical variables were compared between patients with mild and severe COVID-19. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for severe COVID-19. The Cox proportional hazards model was used to analyze risk factors for hospital-related death. Survival analysis was performed by the Kaplan-Meier method, and survival differences were assessed by the log-rank test. Receiver operating characteristic (ROC) curves of the SOFA score in different situations were drawn, and the area under the ROC curve was calculated. Results The median SOFA score of all patients was 2 (IQR, 1–3). Patients with severe COVID-19 exhibited a significantly higher SOFA score than patients with mild COVID-19 [3 (IQR, 2–4) vs 1 (IQR, 0–1); P < 0.001]. The SOFA score increased the risk of severe COVID-19, with an odds ratio of 5.851 (95% CI: 3.044–11.245; P < 0.001). The area under the ROC curve (AUC) was used to evaluate the diagnostic accuracy of the SOFA score in predicting severe COVID-19 [cutoff value = 2; AUC = 0.908 (95% CI: 0.857–0.960); sensitivity: 85.20%; specificity: 80.40%] and the risk of death in COVID-19 patients [cutoff value = 5; AUC = 0.995 (95% CI: 0.985-1.000); sensitivity: 100.00%; specificity: 95.40%]. Regarding the 60-day mortality rates of patients in the two groups classified by the optimal cutoff value of the SOFA score (5), patients in the high SOFA score group (SOFA score ≥ 5) had a significantly greater risk of death than those in the low SOFA score group (SOFA score < 5). Conclusion The SOFA score could be used to evaluate the severity and 60-day mortality of COVID-19. The SOFA score may be an independent risk factor for in-hospital death.

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