Siber Veysi, Erdem Ahmet Burak
Department of Emergency Medicine, Ankara Etlik City Hospital, Ankara-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2025 Sep;31(9):891-899. doi: 10.14744/tjtes.2025.55728.
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.
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).
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%).
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.
快速序贯器官衰竭评估（qSOFA）评分广泛用于脓毒症患者的床旁风险分层。然而，其有限的敏感性可能会妨碍早期识别。将血清乳酸水平纳入qSOFA评分的乳酸增强型qSOFA（LqSOFA）可能会提高预后准确性。本研究旨在评估LqSOFA在预测脓毒症患者早期（24小时）和晚期（30天）死亡率以及重症监护病房（ICU）入住率方面的诊断性能。
这项回顾性描述性研究纳入了年龄≥18岁、根据Sepsis-3标准诊断为脓毒症并于2024年7月1日至2024年12月31日入住三级教学医院急诊科（ED）的患者。通过ICD-10（国际疾病分类第10版）编码识别患者，临床确诊诊断。使用初始生命体征和静脉血乳酸水平计算qSOFA和LqSOFA评分。主要结局为24小时和30天死亡率；将ICU入住率作为次要结局进行评估。使用SPSS v27和Jamovi v2.5.7进行统计分析。使用受试者工作特征（ROC）曲线分析评估评分的诊断性能。计算曲线下面积（AUC）、敏感性、特异性和预测值，并使用DeLong检验进行AUC比较（p<0.05认为具有统计学意义）。
共纳入236例患者（中位年龄：75岁；53%为男性）。24小时和30天死亡率分别为20.3%和36.4%。在预测24小时死亡率方面，LqSOFA的诊断准确性显著高于qSOFA（AUC：0.709对0.673；p<0.05）。虽然LqSOFA在预测30天死亡率方面也显示出较高的AUC，但差异无统计学意义。尽管如此，LqSOFA表现出更高的特异性和阳性预测值。对于ICU入住，LqSOFA的敏感性高于qSOFA（79%对57%）。
在预测急诊科脓毒症患者的死亡率和ICU入住率方面，LqSOFA优于qSOFA。鉴于其简单性、客观性和易于实施，LqSOFA可作为支持急诊环境中临床决策的实用工具。
