Performance of qSOFA score with initial lactate levels (LqSOFA) compared to common early warning scores for predicting in-hospital mortality and need for critical illness care in septic patients

Abstract

This retrospective cohort study was conducted in Khon Kaen Hospital, Thailand, from January 1, 2019 to October 31, 2019. We collected data from patient records and the Khon Kaen Sepsis database. We compared the performances of LqSOFA to that of other EWSs (qSOFA, MEWS, NEWS, and SOS) in predicting in-hospital mortality and requirement for intensive care within 48 hours by determining the area under the receiver operating characteristic curves (AUROCs) and their 95% confidence interval (95% CI). The AUROCs of LqSOFA and other EWSs were compared using Hanley and McNeil method at a significance level of 0.05. Results 1237 septic patients who met the eligibility criteria were included in this study. Of 1237 patients, there were 386 hospital death (31.2%). The NEWS was found to be the best EWS for predicting in-hospital mortality, with an AUROC 0.660 (95% CI: 0.629-0.692) and also demonstrated the best EWS for predicting the use of endotracheal tube (ET tube) intubation and mechanical ventilation with an AUROC of 0.752 (95% CI: 0.725-0.780). However, 5-point LqSOFA was the best EWS for predicting death within 48 hours (AUROC 0.698; 95% CI 0.660-0.736), the requirement of vasopressor or inotropic drugs within 48 hours (AUROC 0.718; 95% CI: 0.691-0.745) and also the admission to intensive care unit within 48 hours (AUROC 0.678; 95% CI 0.635-0.722). Conclusion The 5-point LqSOFA performs better for predicting in-hospital mortality and need for intensive care within 48 hours than qSOFA and other EWSs, except NEWS, which performs better for predicting in-hospital mortality and the use of an ET tube and mechanical ventilator than 5-point LqSOFA.