Ulus Travma Acil Cerrahi Derg. Ahead of Print: UTD-55728

Prognostic value of lactate-enhanced qSOFA versus standard qSOFA in predicting mortality among sepsis patients in the emergency department: a retrospective cohort study

Veysi Siber, Ahmet Burak Erdem
Ankara Etlik City Hospital Department Of Emergency Medicine, Ankara, Türkiye

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 – December 31, 2024. Patients were identified through ICD-10 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%).
Conclusions:
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.

Keywords: Sepsis, Emergency Service, Hospital, Lactic Acid, qSOFA Score; Intensive Care Units; Mortality

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Acil serviste sepsis hastalarýnda mortaliteyi tahmin etme konusunda laktatla geliþtirilmiþ qSOFA'nýn standart qSOFA'ya karþý prognostik deðeri: retrospektif bir kohort çalýþmasý

Veysi Siber, Ahmet Burak Erdem
Ankara Etlik Þehir Hastanesi Acil Týp Kliniði, Ankara, Türkiye

Giriþ:
Quick Sequential Organ Failure Assessment (qSOFA) skoru, sepsis hastalarýnda yatak baþý risk sýnýflandýrmasý için yaygýn olarak kullanýlmaktadýr. Ancak sýnýrlý duyarlýlýðý, erken taný konmasýný zorlaþtýrabilir. Serum laktat düzeylerinin qSOFA skoruna entegre edilmesiyle oluþturulan Lactate-enhanced qSOFA (LqSOFA) skoru, prognostik doðruluðu artýrabilir. Bu çalýþmanýn amacý, LqSOFA skorunun erken (24 saat) ve geç (30 gün) mortalite ile yoðun bakým ünitesi (YBÜ) yatýþýný öngörmedeki tanýsal performansýný deðerlendirmektir.
Yöntem:
Bu retrospektif tanýmlayýcý çalýþma, 1 Temmuz 2024 – 31 Aralýk 2024 tarihleri arasýnda üçüncü basamak bir eðitim ve araþtýrma hastanesinin acil servisine baþvuran ve Sepsis-3 kriterlerine göre sepsis tanýsý alan ≥18 yaþ hastalarý kapsamaktadýr. Hastalar ICD-10 kodlarý ile belirlenmiþ, tanýlar klinik olarak doðrulanmýþtýr. qSOFA ve LqSOFA skorlarý, baþvuru anýndaki vital bulgular ve venöz laktat düzeylerine göre hesaplanmýþtýr. Birincil sonuçlar 24 saat ve 30 günlük mortalite; ikincil sonuç ise YBÜ yatýþýdýr. Ýstatistiksel analizler SPSS v27 ve Jamovi v2.5.7 ile yapýlmýþtýr. Tanýsal performans deðerlendirmesi için ROC eðrisi analizi uygulanmýþ; AUC, duyarlýlýk, özgüllük ve kestirim deðerleri hesaplanmýþtýr. AUC karþýlaþtýrmalarý DeLong testi ile yapýlmýþ; p<0.05 anlamlý kabul edilmiþtir.
Bulgular:
Toplam 236 hasta dahil edilmiþtir (medyan yaþ: 75 yýl; %53 erkek). Yirmi dört saatlik ve 30 günlük mortalite oranlarý sýrasýyla %20,3 ve %36,4 olarak bulunmuþtur. LqSOFA, 24 saatlik mortaliteyi öngörmede qSOFA’ya göre anlamlý derecede daha yüksek tanýsal doðruluk göstermiþtir (AUC: 0.709 vs. 0.673; p<0.05). LqSOFA’nýn 30 günlük mortalite için AUC deðeri daha yüksek olmasýna raðmen, fark istatistiksel olarak anlamlý deðildir. Bununla birlikte, LqSOFA daha yüksek özgüllük ve pozitif kestirim deðeri sergilemiþtir. YBÜ yatýþýný öngörmede, LqSOFA skoru qSOFA’ya göre daha yüksek duyarlýlýða sahiptir (%79 vs. %57).
Sonuç:
LqSOFA skoru, mortalite ve YBÜ yatýþýný öngörmede qSOFA skoruna göre daha iyi tanýsal performans sunmaktadýr. Basitliði, nesnelliði ve hýzlý uygulanabilirliði sayesinde, LqSOFA acil servislerde klinik karar verme sürecini destekleyen pratik bir araç olarak kullanýlabilir.

Anahtar Kelimeler: Sepsis, Hastane Acil Servisi, Laktik Asit, qSOFA Skoru, Yoðun Bakým Üniteleri, Mortalite

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