Prognostic value of lactate-enhanced quick sequential organ failure assessment (qSOFA) versus standard qSOFA in predicting mortality among sepsis patients in the emergency department: A retrospective cohort study.

Background: The quick Sequential Organ Failure Assessment (qSOFA) score is widely used for bedside risk stratification in sepsis patients. However, its limited sensitivity may hinder early identification. The lactate-enhanced qSOFA (LqSOFA), which incorporates serum lactate levels into the qSOFA score, may improve prognostic accuracy. This study aimed to evaluate the diagnostic performance of LqSOFA in predicting early (24-hour) and late (30-day) mortality, as well as intensive care unit (ICU) admission, among patients with sepsis.

Methods: This retrospective descriptive study included patients aged ≥18 years who were diagnosed with sepsis based on Sepsis-3 criteria and admitted to the emergency department (ED) of a tertiary-care teaching hospital between July 1, 2024 and December 31, 2024. Patients were identified through ICD-10 (International Classification of Diseases, 10th Revision) codes, and diagnoses were clinically confirmed. qSOFA and LqSOFA scores were calculated using initial vital signs and venous lactate levels. The primary outcomes were 24-hour and 30-day mortality; ICU admission was assessed as a secondary outcome. Statistical analyses were conducted using SPSS v27 and Jamovi v2.5.7. The diagnostic performance of the scores was evaluated using receiver operating characteristic (ROC) curve analysis. Area under the curve (AUC), sensitivity, specificity, and predictive values were calculated, and AUC comparisons were performed using the DeLong test (p<0.05 considered significant).

Results: A total of 236 patients were included (median age: 75 years; 53% male). The 24-hour and 30-day mortality rates were 20.3% and 36.4%, respectively. LqSOFA demonstrated significantly higher diagnostic accuracy than qSOFA for predicting 24-hour mortality (AUC: 0.709 vs. 0.673; p<0.05). Although LqSOFA also showed a higher AUC for 30-day mortality, the difference was not statistically significant. Nevertheless, LqSOFA exhibited superior specificity and positive predictive value. For ICU admission, LqSOFA demonstrated greater sensitivity than qSOFA (79% vs. 57%).

Conclusion: LqSOFA outperforms qSOFA in predicting mortality and ICU admission among sepsis patients in the emergency department. Given its simplicity, objectivity, and ease of implementation, LqSOFA may serve as a practical tool to support clinical decision-making in emergency settings.